BACKGROUND: Rapid initiation and up-titration of guideline-directed medical therapy (GDMT) are critical for improving outcomes in heart failure with reduced ejection fraction (HFrEF), yet initiation is frequently delayed and target doses are often not achieved in routine clinical care. We assessed whether a predefined standardised home-based titration strategy supported by telemonitoring enhances GDMT optimisation compared with standard of care. METHODS: This study compared the TELEmonitored FAst Standardized Titration for Efficient Response in Heart Failure with reduced ejection fraction (TELEFASTER-HF) cohort (n=60) that underwent standardised, home-based GDMT titration with a contemporaneous standard-of-care cohort (n=65). Groups were balanced using inverse probability of treatment weighting. Outcomes included time to optimal medical therapy (OMT), comparative attainment of GDMT doses at 8 weeks and GDMT persistence up to 12 months after the study index. RESULTS: The time to OMT was substantially shorter in TELEFASTER-HF patients compared with the standard-of-care cohort (median 48 vs 321 days, HR 16.1, 95% CI 8.3 to 31.2, p<0.001). Compared with standard-of care, TELEFASTER-HF care was associated with higher GDMT dose categories and achievement of higher rates of GDMT target doses across all drug classes needing titration at all follow-up time points. Exploratory analyses showed no heart failure hospitalisations in the TELEFASTER-HF group during 12 months from index compared with 26 events in the control cohort. CONCLUSIONS: A standardised, telemonitored, home-based GDMT titration strategy was associated with faster, more comprehensive and more durable optimisation of GDMT in patients with HFrEF compared with standard of care. This approach may help address persistent GDMT implementation gaps.