Purpose: In spite of the apparent clinical results, the translation of the results of such clinical results into clinical prescribing has been slow and incomplete in real practice. So, we evaluate the proportion and clinical effects of target dosage in systolic heart failure (SHF). Method: Between Oct 2002 and June 2004, 120 patients with acute exacerbation (<1 month) of SHF were included. The BNP (Triage) level, and clinical parameters were analyzed on admission and at follow-up period (13.8 months). Bad clinical parameter was defined as readmission or death. Target dosages of ACE (angiotensin converting enzyme) or ARB (angiotensin receptor blockade) and BB (beta blockade) were defined as follows; Ramipril 10mg, Enalapril 20mg, Cilazapril 5mg, Losartan 100mg, Candesartan 16mg, Carvedilol 50mg. We are checked portion of approaching target dosage and usage of drugs. We are divided two groups: Group I (patients with approaching target dosage of any drugs: ACEI or ARB or BB), Group II (patients with not approaching target dosage of any drugs). Results: 1.Mean age was 68.0 and male was 50.0%. Ejection fraction of LV was 41.9%. NYHA class score was 3.2 2.Initial use of ACEI was 71.7%, ARB was 11.7%, BB was 57.5 & Aldactone was 80.0%. The use of ACEI for maintaining was 43.3%, ARB was 26.7.%, BB was 52.5% & Aldactone was 67.5%. Combinations of polypharmacy in maintain use was ACEI or ARB + BB + Diuretics + Aldactone (35.0%), ACEI or ARB + Diuretics + Aldactone (25.8%), BB + Diuretics + Aldactone (6.7%). The patients with approaching target dosage of any drugs (Group 1) was 10.8% (n=13) and Group II was 89.2% (n=107). 3.There were no significant differences for clinical parameters, BNP level, drug combinations and total dosage between the group I and II. Clinical outcomes were 15.4 % in group I and 13.1% in group II. Only significant difference was BNP reduction ratio (66.4짹25.7 vs. 29.3짹35.2%, p=0.045). Conclusions: Most patients were used effective drugs initially, but the only few patients were used target dosage for maintaining. There were not significant differences in clinical effects except BNP reduction ratio, but further clinical evaluation with large data will be needed.