Protocol-driven approach to guideline-directed medical therapy optimization for heart failure: A real-world application to recovery
The objective of our study was to evaluate the real-world effects of an aggressive, personalized protocol for guideline-directed medical therapy (GDMT) titration in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We conducted a two-center retrospective cohort study. Patients...
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Published in | American heart journal plus Vol. 45; p. 100438 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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01.09.2024
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Abstract | The objective of our study was to evaluate the real-world effects of an aggressive, personalized protocol for guideline-directed medical therapy (GDMT) titration in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We conducted a two-center retrospective cohort study. Patients with HFrEF who presented to a HF clinic from January 2020 to December 2022 were placed on a GDMT protocol. 180 patients were included in the study. Mean GDMT score significantly increased from 4.7 to 5.9 (p < 0.001) between initial and final visits. Mean left ventricular ejection fraction (LVEF) significantly increased from 28 % to 33 % (+5 %, p < 0.001). 27 (15.7 %) of the 172 patients with complete New York Heart Association (NYHA) classification data had improvement by at least 1 class, while 2 (1.2 %) patients had worsening NYHA classification. 140 (77.8 %) patients had no unplanned hospitalizations between visits. 21 (11.7 %) patients had an unplanned hospitalization for acute HF during the study period with a mean time from first clinic visit to hospitalization of 183 days (range: 13–821 days). 2 (1.1 %) patients were hospitalized due to GDMT-associated adverse drug events (i.e. hypotension, hyperkalemia). 7 (3.9 %) patients died during the study period, which was lower than the predicted 1-year death rate for our cohort (12.3 %) using the MAGGIC score. In conclusion, an aggressive, personalized protocol for GDMT titration in patients with HFrEF led to significant improvements in LVEF, NYHA classification, hospitalization, and mortality in a real-world setting. This protocol may help serve as a road map to lessen the gap between clinical knowledge and practice surrounding optimization of GDMT and move HFrEF patients toward a path to recovery. |
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AbstractList | The objective of our study was to evaluate the real-world effects of an aggressive, personalized protocol for guideline-directed medical therapy (GDMT) titration in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We conducted a two-center retrospective cohort study. Patients with HFrEF who presented to a HF clinic from January 2020 to December 2022 were placed on a GDMT protocol. 180 patients were included in the study. Mean GDMT score significantly increased from 4.7 to 5.9 (p < 0.001) between initial and final visits. Mean left ventricular ejection fraction (LVEF) significantly increased from 28 % to 33 % (+5 %, p < 0.001). 27 (15.7 %) of the 172 patients with complete New York Heart Association (NYHA) classification data had improvement by at least 1 class, while 2 (1.2 %) patients had worsening NYHA classification. 140 (77.8 %) patients had no unplanned hospitalizations between visits. 21 (11.7 %) patients had an unplanned hospitalization for acute HF during the study period with a mean time from first clinic visit to hospitalization of 183 days (range: 13–821 days). 2 (1.1 %) patients were hospitalized due to GDMT-associated adverse drug events (i.e. hypotension, hyperkalemia). 7 (3.9 %) patients died during the study period, which was lower than the predicted 1-year death rate for our cohort (12.3 %) using the MAGGIC score. In conclusion, an aggressive, personalized protocol for GDMT titration in patients with HFrEF led to significant improvements in LVEF, NYHA classification, hospitalization, and mortality in a real-world setting. This protocol may help serve as a road map to lessen the gap between clinical knowledge and practice surrounding optimization of GDMT and move HFrEF patients toward a path to recovery. The objective of our study was to evaluate the real-world effects of an aggressive, personalized protocol for guideline-directed medical therapy (GDMT) titration in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We conducted a two-center retrospective cohort study. Patients with HFrEF who presented to a HF clinic from January 2020 to December 2022 were placed on a GDMT protocol. 180 patients were included in the study. Mean GDMT score significantly increased from 4.7 to 5.9 (p < 0.001) between initial and final visits. Mean left ventricular ejection fraction (LVEF) significantly increased from 28 % to 33 % (+5 %, p < 0.001). 27 (15.7 %) of the 172 patients with complete New York Heart Association (NYHA) classification data had improvement by at least 1 class, while 2 (1.2 %) patients had worsening NYHA classification. 140 (77.8 %) patients had no unplanned hospitalizations between visits. 21 (11.7 %) patients had an unplanned hospitalization for acute HF during the study period with a mean time from first clinic visit to hospitalization of 183 days (range: 13-821 days). 2 (1.1 %) patients were hospitalized due to GDMT-associated adverse drug events (i.e. hypotension, hyperkalemia). 7 (3.9 %) patients died during the study period, which was lower than the predicted 1-year death rate for our cohort (12.3 %) using the MAGGIC score. In conclusion, an aggressive, personalized protocol for GDMT titration in patients with HFrEF led to significant improvements in LVEF, NYHA classification, hospitalization, and mortality in a real-world setting. This protocol may help serve as a road map to lessen the gap between clinical knowledge and practice surrounding optimization of GDMT and move HFrEF patients toward a path to recovery.The objective of our study was to evaluate the real-world effects of an aggressive, personalized protocol for guideline-directed medical therapy (GDMT) titration in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We conducted a two-center retrospective cohort study. Patients with HFrEF who presented to a HF clinic from January 2020 to December 2022 were placed on a GDMT protocol. 180 patients were included in the study. Mean GDMT score significantly increased from 4.7 to 5.9 (p < 0.001) between initial and final visits. Mean left ventricular ejection fraction (LVEF) significantly increased from 28 % to 33 % (+5 %, p < 0.001). 27 (15.7 %) of the 172 patients with complete New York Heart Association (NYHA) classification data had improvement by at least 1 class, while 2 (1.2 %) patients had worsening NYHA classification. 140 (77.8 %) patients had no unplanned hospitalizations between visits. 21 (11.7 %) patients had an unplanned hospitalization for acute HF during the study period with a mean time from first clinic visit to hospitalization of 183 days (range: 13-821 days). 2 (1.1 %) patients were hospitalized due to GDMT-associated adverse drug events (i.e. hypotension, hyperkalemia). 7 (3.9 %) patients died during the study period, which was lower than the predicted 1-year death rate for our cohort (12.3 %) using the MAGGIC score. In conclusion, an aggressive, personalized protocol for GDMT titration in patients with HFrEF led to significant improvements in LVEF, NYHA classification, hospitalization, and mortality in a real-world setting. This protocol may help serve as a road map to lessen the gap between clinical knowledge and practice surrounding optimization of GDMT and move HFrEF patients toward a path to recovery. |
ArticleNumber | 100438 |
Author | Baran, David Velez, Mauricio Bauerlein, E. Joseph Snipelisky, David Estep, Jerry D. Thakkar Rivera, Nina Yan, Crystal Lihong |
Author_xml | – sequence: 1 givenname: Crystal Lihong orcidid: 0000-0003-1724-4231 surname: Yan fullname: Yan, Crystal Lihong email: crystaly@med.miami.edu organization: Divison of Internal Medicine, University of Miami Health System, Miami, FL, USA – sequence: 2 givenname: David surname: Snipelisky fullname: Snipelisky, David organization: Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, USA – sequence: 3 givenname: Mauricio surname: Velez fullname: Velez, Mauricio organization: Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, USA – sequence: 4 givenname: David surname: Baran fullname: Baran, David organization: Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, USA – sequence: 5 givenname: Jerry D. surname: Estep fullname: Estep, Jerry D. organization: Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, USA – sequence: 6 givenname: E. Joseph surname: Bauerlein fullname: Bauerlein, E. Joseph organization: Miami Transplant Institute, Jackson Health System, Miami, FL, USA – sequence: 7 givenname: Nina surname: Thakkar Rivera fullname: Thakkar Rivera, Nina organization: Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, USA |
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Cites_doi | 10.1056/NEJMoa1911303 10.1016/j.ahj.2010.12.009 10.1161/JAHA.119.013441 10.7205/MILMED-D-17-00017 10.1161/CIRCHEARTFAILURE.121.008335 10.1056/NEJM199909023411001 10.1016/j.jacc.2019.02.015 10.1016/j.jacc.2017.04.001 10.1016/j.jacc.2021.11.033 10.1093/eurheartj/ehs337 10.1161/CIRCULATIONAHA.109.934471 10.1016/j.ahj.2007.03.030 10.1016/j.cardfail.2023.03.012 10.1016/S0140-6736(10)61259-7 10.1016/S0140-6736(22)02076-1 10.1002/ehf2.13417 10.1056/NEJMoa2022190 10.1016/j.jchf.2020.08.017 10.1056/NEJMoa1009492 10.1016/j.jacc.2018.04.070 10.1056/NEJMoa1409077 10.1016/j.jacc.2010.05.011 10.1016/S0140-6736(18)32279-7 |
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Keywords | Heart failure Titration Protocol Guideline-directed medical therapy Reduced ejection fraction |
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References | Slade, Lee, Park, Liu, Heidenreich, Allaudeen (bb0125) 2022; 48 Ather, Chan, Chillar, Aguilar, Pritchett, Ramasubbu (bb0070) 2011; 161 Fonarow, Albert, Curtis, Stough, Gheorghiade, Heywood (bb0110) 2010; 122 Srivastava, DeVore, Hellkamp, Thomas, Albert, Butler (bb0050) 2021; 9 Zheng, Mednick, Heidenreich, Sandhu (bb0135) 2023; 29 Vergaro, Ghionzoli, Innocenti, Taddei, Giannoni, Valleggi (bb0030) 2019; 8 Böhm, Swedberg, Komajda, Borer, Ford, Dubost-Brama (bb0080) 2010; 376 Greene, Fonarow, DeVore, Sharma, Vaduganathan, Albert (bb0105) 2019; 73 Khan, Sreenivasan, Lateef, Abougergi, Greene, Ahmad (bb0045) 2021; 14 Kotecha, Flather, Altman, Holmes, Rosano, Wikstrand (bb0075) 2017; 69 Pocock, Ariti, McMurray, Maggioni, Køber, Squire (bb0020) 2012; 34 (bb0005) 2018; 392 Kramer, Trikalinos, Kent, Antonopoulos, Konstam, Udelson (bb0060) 2010; 56 Lin, Chin, Sicignano, Evans (bb0040) 2017; 182 Wang, Youngson, Bakal, Thomas, McAlister, Oudit (bb0055) 2021; 8 Fiuzat, Hamo, Butler, Abraham, DeFilippis, Fonarow (bb0025) 2022; 79 Zannad, McMurray, Krum, van Veldhuisen, Swedberg, Shi (bb0100) 2010; 364 Packer, Anker, Butler, Filippatos, Pocock, Carson (bb0090) 2020; 383 Fonarow, Yancy, Albert, Curtis, Stough, Gheorghiade (bb0130) 2007; 154 Balakumaran, Patil, Marsh, Ingrassia, Kuo, Jacoby (bb0115) 2019; 22 Yancy, Jessup, Bozkurt, Butler, Casey, Colvin (bb0085) 2016; 134 Mebazaa, Davison, Chioncel, Cohen-Solal, Diaz, Filippatos (bb0120) 2022; 400 McMurray, Solomon, Inzucchi, Køber, Kosiborod, Martinez (bb0035) 2019; 381 Pitt, Zannad, Remme, Cody, Castaigne, Perez (bb0095) 1999; 341 McMurray, Packer, Desai, Gong, Lefkowitz, Rizkala (bb0065) 2014; 371 Greene, Butler, Albert, DeVore, Sharma, Duffy (bb0015) 2018; 72 Heidenreich, Bozkurt, Aguilar, Allen, Byun, Colvin (bb0010) 2022; 145 Wang (10.1016/j.ahjo.2024.100438_bb0055) 2021; 8 Heidenreich (10.1016/j.ahjo.2024.100438_bb0010) 2022; 145 Khan (10.1016/j.ahjo.2024.100438_bb0045) 2021; 14 Greene (10.1016/j.ahjo.2024.100438_bb0105) 2019; 73 Böhm (10.1016/j.ahjo.2024.100438_bb0080) 2010; 376 Kotecha (10.1016/j.ahjo.2024.100438_bb0075) 2017; 69 Greene (10.1016/j.ahjo.2024.100438_bb0015) 2018; 72 McMurray (10.1016/j.ahjo.2024.100438_bb0035) 2019; 381 Zannad (10.1016/j.ahjo.2024.100438_bb0100) 2010; 364 Fonarow (10.1016/j.ahjo.2024.100438_bb0110) 2010; 122 Ather (10.1016/j.ahjo.2024.100438_bb0070) 2011; 161 Pocock (10.1016/j.ahjo.2024.100438_bb0020) 2012; 34 Slade (10.1016/j.ahjo.2024.100438_bb0125) 2022; 48 Fonarow (10.1016/j.ahjo.2024.100438_bb0130) 2007; 154 Fiuzat (10.1016/j.ahjo.2024.100438_bb0025) 2022; 79 Lin (10.1016/j.ahjo.2024.100438_bb0040) 2017; 182 (10.1016/j.ahjo.2024.100438_bb0005) 2018; 392 Balakumaran (10.1016/j.ahjo.2024.100438_bb0115) 2019; 22 Srivastava (10.1016/j.ahjo.2024.100438_bb0050) 2021; 9 Vergaro (10.1016/j.ahjo.2024.100438_bb0030) 2019; 8 Packer (10.1016/j.ahjo.2024.100438_bb0090) 2020; 383 Kramer (10.1016/j.ahjo.2024.100438_bb0060) 2010; 56 Pitt (10.1016/j.ahjo.2024.100438_bb0095) 1999; 341 McMurray (10.1016/j.ahjo.2024.100438_bb0065) 2014; 371 Yancy (10.1016/j.ahjo.2024.100438_bb0085) 2016; 134 Zheng (10.1016/j.ahjo.2024.100438_bb0135) 2023; 29 Mebazaa (10.1016/j.ahjo.2024.100438_bb0120) 2022; 400 |
References_xml | – volume: 9 start-page: 28 year: 2021 end-page: 38 ident: bb0050 article-title: Heart failure hospitalization and guideline-directed prescribing patterns among heart failure with reduced ejection fraction patients publication-title: JACC Heart Fail. contributor: fullname: Butler – volume: 161 start-page: 567 year: 2011 end-page: 573 ident: bb0070 article-title: Association of systolic blood pressure with mortality in patients with heart failure with reduced ejection fraction: a complex relationship publication-title: Am. Heart J. contributor: fullname: Ramasubbu – volume: 8 year: 2019 ident: bb0030 article-title: Noncardiac versus cardiac mortality in heart failure with preserved, midrange, and reduced ejection fraction publication-title: J. Am. Heart Assoc. contributor: fullname: Valleggi – volume: 364 start-page: 11 year: 2010 end-page: 21 ident: bb0100 article-title: Eplerenone in patients with systolic heart failure and mild symptoms publication-title: N. Engl. J. Med. contributor: fullname: Shi – volume: 400 start-page: 1938 year: 2022 end-page: 1952 ident: bb0120 article-title: Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial publication-title: Lancet contributor: fullname: Filippatos – volume: 341 start-page: 709 year: 1999 end-page: 717 ident: bb0095 article-title: The effect of spironolactone on morbidity and mortality in patients with severe heart failure publication-title: N. Engl. J. Med. contributor: fullname: Perez – volume: 371 start-page: 993 year: 2014 end-page: 1004 ident: bb0065 article-title: Angiotensin–neprilysin inhibition versus enalapril in heart failure publication-title: N. Engl. J. Med. contributor: fullname: Rizkala – volume: 383 start-page: 1413 year: 2020 end-page: 1424 ident: bb0090 article-title: Cardiovascular and renal outcomes with empagliflozin in heart failure publication-title: N. Engl. J. Med. contributor: fullname: Carson – volume: 381 start-page: 1995 year: 2019 end-page: 2008 ident: bb0035 article-title: Dapagliflozin in patients with heart failure and reduced ejection fraction publication-title: N. Engl. J. Med. contributor: fullname: Martinez – volume: 56 start-page: 392 year: 2010 end-page: 406 ident: bb0060 article-title: Quantitative evaluation of drug or device effects on ventricular remodeling as predictors of therapeutic effects on mortality in patients with heart failure and reduced ejection fraction: a meta-analytic approach publication-title: J. Am. Coll. Cardiol. contributor: fullname: Udelson – volume: 8 start-page: 3106 year: 2021 end-page: 3118 ident: bb0055 article-title: Cardiac reverse remodelling and health status in patients with chronic heart failure publication-title: ESC Heart Fail. contributor: fullname: Oudit – volume: 122 start-page: 585 year: 2010 end-page: 596 ident: bb0110 article-title: Improving evidence-based care for heart failure in outpatient cardiology practices publication-title: Circulation contributor: fullname: Heywood – volume: 154 start-page: 12 year: 2007 end-page: 38 ident: bb0130 article-title: Improving the use of evidence-based heart failure therapies in the outpatient setting: the IMPROVE HF performance improvement registry publication-title: Am. Heart J. contributor: fullname: Gheorghiade – volume: 29 start-page: 1000 year: 2023 end-page: 1013 ident: bb0135 article-title: Pharmacist- and nurse-led medical optimization in heart failure: a systematic review and Meta-analysis publication-title: J. Card. Fail. contributor: fullname: Sandhu – volume: 69 start-page: 2885 year: 2017 end-page: 2896 ident: bb0075 article-title: Heart rate and rhythm and the benefit of beta-blockers in patients with heart failure publication-title: J. Am. Coll. Cardiol. contributor: fullname: Wikstrand – volume: 392 start-page: 1789 year: 2018 end-page: 1858 ident: bb0005 article-title: Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 publication-title: Lancet – volume: 73 start-page: 2365 year: 2019 end-page: 2383 ident: bb0105 article-title: Titration of medical therapy for heart failure with reduced ejection fraction publication-title: J. Am. Coll. Cardiol. contributor: fullname: Albert – volume: 145 start-page: e895 year: 2022 end-page: e1032 ident: bb0010 article-title: 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines publication-title: Circulation contributor: fullname: Colvin – volume: 134 start-page: e282 year: 2016 end-page: e293 ident: bb0085 article-title: 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America publication-title: Circulation contributor: fullname: Colvin – volume: 376 start-page: 886 year: 2010 end-page: 894 ident: bb0080 article-title: Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial publication-title: Lancet contributor: fullname: Dubost-Brama – volume: 79 start-page: 504 year: 2022 end-page: 510 ident: bb0025 article-title: Optimal background pharmacological therapy for heart failure patients in clinical trials: JACC review topic of the week publication-title: J. Am. Coll. Cardiol. contributor: fullname: Fonarow – volume: 14 year: 2021 ident: bb0045 article-title: Trends in 30- and 90-day readmission rates for heart failure publication-title: Circ. Heart Fail. contributor: fullname: Ahmad – volume: 48 start-page: 25 year: 2022 end-page: 32 ident: bb0125 article-title: Harnessing the potential of primary care pharmacists to improve heart failure management publication-title: Jt. Comm. J. Qual. Patient Saf. contributor: fullname: Allaudeen – volume: 182 start-page: e1932 year: 2017 end-page: e1937 ident: bb0040 article-title: Repeat hospitalizations predict mortality in patients with heart failure publication-title: Mil. Med. contributor: fullname: Evans – volume: 22 start-page: 1 year: 2019 end-page: 5 ident: bb0115 article-title: Evaluation of a guideline directed medical therapy titration program in patients with heart failure with reduced ejection fraction publication-title: Int. J. Cardiol. Heart Vasc. contributor: fullname: Jacoby – volume: 72 start-page: 351 year: 2018 end-page: 366 ident: bb0015 article-title: Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry publication-title: J. Am. Coll. Cardiol. contributor: fullname: Duffy – volume: 34 start-page: 1404 year: 2012 end-page: 1413 ident: bb0020 article-title: Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies publication-title: Eur. Heart J. contributor: fullname: Squire – volume: 381 start-page: 1995 issue: 21 year: 2019 ident: 10.1016/j.ahjo.2024.100438_bb0035 article-title: Dapagliflozin in patients with heart failure and reduced ejection fraction publication-title: N. Engl. J. Med. doi: 10.1056/NEJMoa1911303 contributor: fullname: McMurray – volume: 145 start-page: e895 issue: 18 year: 2022 ident: 10.1016/j.ahjo.2024.100438_bb0010 article-title: 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines publication-title: Circulation contributor: fullname: Heidenreich – volume: 161 start-page: 567 issue: 3 year: 2011 ident: 10.1016/j.ahjo.2024.100438_bb0070 article-title: Association of systolic blood pressure with mortality in patients with heart failure with reduced ejection fraction: a complex relationship publication-title: Am. Heart J. doi: 10.1016/j.ahj.2010.12.009 contributor: fullname: Ather – volume: 8 issue: 20 year: 2019 ident: 10.1016/j.ahjo.2024.100438_bb0030 article-title: Noncardiac versus cardiac mortality in heart failure with preserved, midrange, and reduced ejection fraction publication-title: J. Am. Heart Assoc. doi: 10.1161/JAHA.119.013441 contributor: fullname: Vergaro – volume: 48 start-page: 25 issue: 1 year: 2022 ident: 10.1016/j.ahjo.2024.100438_bb0125 article-title: Harnessing the potential of primary care pharmacists to improve heart failure management publication-title: Jt. Comm. J. Qual. Patient Saf. contributor: fullname: Slade – volume: 182 start-page: e1932 issue: 9 year: 2017 ident: 10.1016/j.ahjo.2024.100438_bb0040 article-title: Repeat hospitalizations predict mortality in patients with heart failure publication-title: Mil. Med. doi: 10.7205/MILMED-D-17-00017 contributor: fullname: Lin – volume: 14 issue: 4 year: 2021 ident: 10.1016/j.ahjo.2024.100438_bb0045 article-title: Trends in 30- and 90-day readmission rates for heart failure publication-title: Circ. Heart Fail. doi: 10.1161/CIRCHEARTFAILURE.121.008335 contributor: fullname: Khan – volume: 341 start-page: 709 issue: 10 year: 1999 ident: 10.1016/j.ahjo.2024.100438_bb0095 article-title: The effect of spironolactone on morbidity and mortality in patients with severe heart failure publication-title: N. Engl. J. Med. doi: 10.1056/NEJM199909023411001 contributor: fullname: Pitt – volume: 73 start-page: 2365 issue: 19 year: 2019 ident: 10.1016/j.ahjo.2024.100438_bb0105 article-title: Titration of medical therapy for heart failure with reduced ejection fraction publication-title: J. Am. Coll. Cardiol. doi: 10.1016/j.jacc.2019.02.015 contributor: fullname: Greene – volume: 69 start-page: 2885 issue: 24 year: 2017 ident: 10.1016/j.ahjo.2024.100438_bb0075 article-title: Heart rate and rhythm and the benefit of beta-blockers in patients with heart failure publication-title: J. Am. Coll. Cardiol. doi: 10.1016/j.jacc.2017.04.001 contributor: fullname: Kotecha – volume: 79 start-page: 504 issue: 5 year: 2022 ident: 10.1016/j.ahjo.2024.100438_bb0025 article-title: Optimal background pharmacological therapy for heart failure patients in clinical trials: JACC review topic of the week publication-title: J. Am. Coll. Cardiol. doi: 10.1016/j.jacc.2021.11.033 contributor: fullname: Fiuzat – volume: 34 start-page: 1404 issue: 19 year: 2012 ident: 10.1016/j.ahjo.2024.100438_bb0020 article-title: Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies publication-title: Eur. Heart J. doi: 10.1093/eurheartj/ehs337 contributor: fullname: Pocock – volume: 122 start-page: 585 issue: 6 year: 2010 ident: 10.1016/j.ahjo.2024.100438_bb0110 article-title: Improving evidence-based care for heart failure in outpatient cardiology practices publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.109.934471 contributor: fullname: Fonarow – volume: 134 start-page: e282 issue: 13 year: 2016 ident: 10.1016/j.ahjo.2024.100438_bb0085 publication-title: Circulation contributor: fullname: Yancy – volume: 154 start-page: 12 issue: 1 year: 2007 ident: 10.1016/j.ahjo.2024.100438_bb0130 article-title: Improving the use of evidence-based heart failure therapies in the outpatient setting: the IMPROVE HF performance improvement registry publication-title: Am. Heart J. doi: 10.1016/j.ahj.2007.03.030 contributor: fullname: Fonarow – volume: 29 start-page: 1000 issue: 7 year: 2023 ident: 10.1016/j.ahjo.2024.100438_bb0135 article-title: Pharmacist- and nurse-led medical optimization in heart failure: a systematic review and Meta-analysis publication-title: J. Card. Fail. doi: 10.1016/j.cardfail.2023.03.012 contributor: fullname: Zheng – volume: 376 start-page: 886 issue: 9744 year: 2010 ident: 10.1016/j.ahjo.2024.100438_bb0080 article-title: Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial publication-title: Lancet doi: 10.1016/S0140-6736(10)61259-7 contributor: fullname: Böhm – volume: 400 start-page: 1938 issue: 10367 year: 2022 ident: 10.1016/j.ahjo.2024.100438_bb0120 article-title: Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial publication-title: Lancet doi: 10.1016/S0140-6736(22)02076-1 contributor: fullname: Mebazaa – volume: 8 start-page: 3106 issue: 4 year: 2021 ident: 10.1016/j.ahjo.2024.100438_bb0055 article-title: Cardiac reverse remodelling and health status in patients with chronic heart failure publication-title: ESC Heart Fail. doi: 10.1002/ehf2.13417 contributor: fullname: Wang – volume: 383 start-page: 1413 issue: 15 year: 2020 ident: 10.1016/j.ahjo.2024.100438_bb0090 article-title: Cardiovascular and renal outcomes with empagliflozin in heart failure publication-title: N. Engl. J. Med. doi: 10.1056/NEJMoa2022190 contributor: fullname: Packer – volume: 9 start-page: 28 issue: 1 year: 2021 ident: 10.1016/j.ahjo.2024.100438_bb0050 article-title: Heart failure hospitalization and guideline-directed prescribing patterns among heart failure with reduced ejection fraction patients publication-title: JACC Heart Fail. doi: 10.1016/j.jchf.2020.08.017 contributor: fullname: Srivastava – volume: 364 start-page: 11 issue: 1 year: 2010 ident: 10.1016/j.ahjo.2024.100438_bb0100 article-title: Eplerenone in patients with systolic heart failure and mild symptoms publication-title: N. Engl. J. Med. doi: 10.1056/NEJMoa1009492 contributor: fullname: Zannad – volume: 72 start-page: 351 issue: 4 year: 2018 ident: 10.1016/j.ahjo.2024.100438_bb0015 article-title: Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry publication-title: J. Am. Coll. Cardiol. doi: 10.1016/j.jacc.2018.04.070 contributor: fullname: Greene – volume: 22 start-page: 1 year: 2019 ident: 10.1016/j.ahjo.2024.100438_bb0115 article-title: Evaluation of a guideline directed medical therapy titration program in patients with heart failure with reduced ejection fraction publication-title: Int. J. Cardiol. Heart Vasc. contributor: fullname: Balakumaran – volume: 371 start-page: 993 issue: 11 year: 2014 ident: 10.1016/j.ahjo.2024.100438_bb0065 article-title: Angiotensin–neprilysin inhibition versus enalapril in heart failure publication-title: N. Engl. J. Med. doi: 10.1056/NEJMoa1409077 contributor: fullname: McMurray – volume: 56 start-page: 392 issue: 5 year: 2010 ident: 10.1016/j.ahjo.2024.100438_bb0060 article-title: Quantitative evaluation of drug or device effects on ventricular remodeling as predictors of therapeutic effects on mortality in patients with heart failure and reduced ejection fraction: a meta-analytic approach publication-title: J. Am. Coll. Cardiol. doi: 10.1016/j.jacc.2010.05.011 contributor: fullname: Kramer – volume: 392 start-page: 1789 issue: 10159 year: 2018 ident: 10.1016/j.ahjo.2024.100438_bb0005 article-title: Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 publication-title: Lancet doi: 10.1016/S0140-6736(18)32279-7 |
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