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The four pillars for treatment of heart failure with reduced ejection fraction (HFrEF) patients include angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin-receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker (BB), mineralocorticoid receptor antagonist (MRA) and sodium-glucose cotransporter-2 inhibitor (SGLT2i), unless contraindicated or not tolerated. They should be started or up titrated to maximally tolerated doses recommended in current guidelines. Despite proven benefits and strong guideline recommendations, their use and dosing in routine clinical practice have traditionally fallen below the levels achieved in clinical trials. This analysis seeks to establish medication use and optimal dosage according to the clinical practice guidelines in HFrEF patients included in the RECOLFACA registry during recruitment and after six-month follow-up. Factors that limit its use could be identified in subsequent analysis. The RECOLFACA registry was performed between 2017 and 2019. A descriptive analysis is performed considering the medication used in HFrEF patients (ACE-I/ARB/ARNI, BB, and/or MRA) and their dosage (<50%, 50-100% or 100% of the dosage recommended in guidelines) during recruitment and at 6-month follow-up. SGLT2i are not included in this analysis because were not available during this period. The registry included 2528 patients, and this analysis included 1661 HFrEF patients from this registry. Among these patients 89.4%, 93.4% and 70.1% received ACE-I/ARB/ARNI, BB and ARM respectively during registry recruitment. At six-month follow-up, a decrease in its use was observed (57.9%, 53.3% and 44.2% respectively). Among patients with established medication during registry recruitment, only 10.4%, 16.5% and 4.7% received target doses of ACE-I/ARB/ARNI, BB or ARM respectively, which increased at six-month follow-up in ACE-I/ARB/ARNI and BB group (12.6% and 21.5% respectively) and decreased in ARM group (3.7%) (Figure 1). Less than 1% of patients were simultaneously receiving target doses of ACE-I/ARB/ARNI, BB and MRA during registry. In HFrEF patients included in this registry, the use and dosage of the three groups of medications evaluated (ACEI/ARB/ARNI, BB and ARM) and that are recommended in current guidelines is low and more worrisome is that after time (6-month follow-up), this percentage is lower, as mentioned in other trials. There is minor increases in the number of patients reaching maximal doses of those therapies during follow-up. We need to continue working to be able to identify factors associated with low adherence, access to medication, and using maximal recommended/tolerated doses. [ABSTRACT FROM AUTHOR]