Murninkas D, et al. - Researchers assessed outcomes of 552 ambulatory patients with heart failure and reduced ejection fraction (left ventricular ejection fraction [LVEF] ≤40%, median age 73 years and median LVEF 35%) managed in a community-based, dedicated clinic. A total of 304 (55%) agreed to attend the clinic and those who were eligible and declined constituted the control group. Those who were more likely to attend the clinic were patients with worse New York Heart Association (NYHA) class; women were more likely to decline. Follow-up was 18-months, during which significant improvements were seen in patients in the dedicated clinic for functional capacity (56% NYHA 3-4 at baseline vs 27% at follow-up, p < 0.001) and LVEF (35% (interquartile range 25, 35) at baseline vs 35% (interquartile range 30, 40) at follow-up, p < 0.001). Better guideline-recommended pharmacological treatment (65% vs 85% receiving beta-blockers, p < 0.001, 65% vs 82% receiving renin-angiotensin inhibitors, p=0.0006, 31% vs 45% receiving mineralocorticoid receptor antagonists, p < 0.001) and improved survival were seen among patients treated in a dedicated clinic vs patients managed routinely. Among patients treated in the clinic overall survival was better, even after censoring the first 4 months to account for potential bias.