After acute decompensated heart failure (ADHF), most patients are often early discharged before treatment optimization. Following months are important to optimize the treatment. We analyzed treatments at discharge and at 3 months after discharge and the impact on outcome in patients with heart failure and reduced left ventricular ejection fraction (HF-REF). French Society of Cardiology conducted a one-day national survey in a randomized sample of 170 hospitals. All hospitalized patients with a confirmed diagnosis of ADHF were included. Datas were recorded during both hospitalizations and one-year follow up. Treatment informations at discharge as well as at 3 months were obtained in 519 patients (age 72±14y, 34% females). At discharge, loop diuretics were prescribed in 89% cases with daily dose of 87±146 mg, ACE-I or ARB in 80% cases with daily dose reaching 36±31% of target dose, beta blocker (BB) in 70% with daily dose of 27±51% of target dose, aldosterone antagonists (AA) in 23% and digoxin in 9%. At 3 months, there was only few changes in mean rates of prescriptions as compared to discharge (Table). Clinical characteristics significantly associated with the lack of prescription at 3 months were creatininemia >15 mg/l for ACE-I/ARB, BB and AA, LVEF >30% for BB and AA, and also COPD for BB. All-cause-mortality at 12 months was 19% with marked differences according to prescription or not of ACE-I/ARB at 3 months (15 vs 29%, p=0.002) as well as BB (15 vs 27%, p=0.008). After adjustment on clinical characteristics (age, blood pressure, creatininemia, LVEF, natriuretic peptides, COPD, diabetes), lack of treatment at 3 months was an independant predictor of mortality especially ACE-I or ARB (HR 2.50 [95%CI 1.33–4.73], p 0.005). Individual treatments are poorly optimized after discharge. Such inertia leads to poor outcome, that suggests a room to improve HF management in the practice, especially in the 3 months after discharge. Table : Treatment changes. Treatment's changes after discharges Stared Stopped Increased dose Decreased dose Median dose at discharge [IQR] Median dose at 3 months [IQR] Loop diuretics 7% 6% 25% 29% 40 mg/day [40–100] 40 mg/day [20–80] ACE-I or ARB 6% 10% 21% 35% 25 % of target dose [25–50] 25 % of target dose [0–50] Betablockers 8% 9% 20% 31% 25 % of target dose [12.5–50] 12.5 % of target dose [0–50] Aldosterone inhibitors 20% 6%