Heart failure (HF) is one of the most common cardiovascular diseases worldwide. The prevalence of heart failure in India is estimated to be about 8-10 million (1). Around 1.8 million hospitalizations occur in India annually due to HF (2). Approximately 50% of these cases can be attributed to HF with reduced ejection fraction (HFrEF), referring to a left ventricular ejection fraction (LVEF) of 40% or less (3). Despite significant advances in treatment, there remains a signific

Patients with coexisting heart failure (HF) and renal dysfunction (RD) face a significantly poorer prognosis compared to those with HF alone, experiencing higher rates of hospitalization, mortality, and morbidity. Managing patients with heart failure with reduced ejection fraction (HFrEF) and renal dysfunction (RD) is challenging due to the risk of further worsening of kidney function, particularly following an episode of acute decompensated heart failure (ADHF). Initiating a