Abstract: Background: We evaluated the impact of a specialized unit on reducing heart failure (HF) readmissions in elderly patients with multiple comorbidities and HFrEF (LVEF < 40%) or mildly reduced EF (LVEF 40-50%), considering different levels of pharmacological optimization. Methods: Retrospective analysis of a cohort of 135 patients. Readmission rates and their association with optimized treatment were analyzed. Results: HF admissions decreased by 51% compared to the previous year (p = 0.013). Sixty percent received quadruple therapy, and 62-71% at least three drugs. NT-proBNP levels dropped by 70% (p < 0.001). Quadruple therapy was associated with fewer readmissions at 12 months (p = 0.036), as were ARNI + BB + MRA (p = 0.016) and MRA monotherapy (p = 0.012). The median time to achieve therapeutic optimization was 52 days (27-82 days). Conclusions: A specialized unit markedly improves therapeutic optimization and reduces readmissions in these patients.

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