ArticleClinical cardiology2021
Mortality and guideline-directed medical therapy in real-world heart failure patients with reduced ejection fraction.
Article in Clinical cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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Who cites it
26 citing papers in PubMed, 46 citations in OpenAlex.
- Why guideline-directed medical therapy depends on more than guidelines: microeconomics of medication use in heart failure.Heart failure reviews · 2026Review
- Comprehensive analysis of heart failure: Characteristics, treatment, and outcomes in a reduced ejection fraction patient cohort from SIDIAP, Catalonia, Spain.Atencion primaria · 2026Article
- Article
- Patterns of Adherence and Persistence to Triple and Quadruple Guideline-Directed Medical Therapy Among US Patients With Heart Failure With Reduced Ejection Fraction.Journal of the American Heart Association · 2026Observational
- Structured Functional Assessment Pathway and Pharmacological Optimization During Cardiovascular Rehabilitation in Chronic Heart Failure: A Retrospective Tertiary Center Study.Life (Basel, Switzerland) · 2026Article
- A Pragmatic Trial Evaluating the Impact of the Anumana Clinical Decision Support Tool for Guideline-Directed Management of Heart Failure (ACT-HF): Clinical trial design and methods.American heart journal plus : cardiology research and practice · 2026Article
- Association of an Algorithm-Generated Medication Optimization Score With Clinical Outcomes in Ambulatory Patients With Heart Failure.Pharmacotherapy · 2026Article
- ChatGPT Applications in Heart Failure: Patient Education, Readability Enhancement, and Clinical Utility.Journal of cardiovascular development and disease · 2025Review
- Prescription Patterns of Sacubitril/Valsartan in an Outpatient Population Diagnosed with Heart Failure with Reduced Ejection Fraction After a Recent Hospitalization.Epidemiologia (Basel, Switzerland) · 2025Article
- Pharmacist-led guideline-directed medical therapy in heart failure: impact analysis in primary care.BMJ open quality · 2025Article
- Tolerability and Adverse Effects in a Specialized Heart Failure Guideline-Directed Medical Therapy Optimization Program.Clinical cardiology · 2025Article
- Review
- Article
- Applications of ChatGPT in Heart Failure Prevention, Diagnosis, Management, and Research: A Narrative Review.Diagnostics (Basel, Switzerland) · 2024Review
- Temporal trends in acute decompensated heart failure outcomes: A single-center 11-year retrospective analysis.International journal of cardiology. Cardiovascular risk and prevention · 2024Article
- The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction.Diagnostics (Basel, Switzerland) · 2024Article
- Impact of Multidisciplinary Heart Failure Clinic on Guideline-Directed Medical Therapy and Clinical Outcomes.The Canadian journal of hospital pharmacy · 2024Article
- Article
- VA Home Telehealth Program for Initiating and Optimizing Heart Failure Guideline-Directed Medical Therapy.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2023Article
- Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Study.Reviews in cardiovascular medicine · 2023Article
Corrections and comments
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Authors and funding
8 authors at 7 institutions in 1 country.
Funding
Abstract
objectiveTo estimate the prevalence of guideline-directed medical therapy (GDMT) in commercially insured US patients with heart failure with reduced ejection fraction (HFrEF) and examine the effect of GDMT on all-cause mortality. GDMT for HFrEF includes pharmacologic therapies such as β-blockers (BB), angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), angiotensin receptor-neprilysin (ARNI), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter inhibitors to reduce morbidity and mortality.
methodsPatients in the Optum Integrated File from 2007 to 2019Q3, ≥18 years, with history of HFrEF, were identified. Patients prescribed both a BB and either an ACE-I, ARB, or ARNI during 6-month post-diagnosis were assigned to the GDMT cohort. All others were assigned to the not on GDMT cohort. The GDMT cohort was further classified by those patients with a record of prescription fills for both classes of medications concurrently (GDMT concurrent medication fills). Mortality at 2 years was assessed with a Cox regression model accounting for baseline demographics, comorbidities, and diuretic use.
resultsThis study identified 14 880 HFrEF patients, of which 70% had a record of GDMT, and 57% had a record of concurrent prescriptions. Patients in the not on GDMT cohort had 29% increased risk of mortality versus GDMT (hazard ratio 1.29; 95% CI (1.19-1.40); p < .0001). As a sensitivity analysis, the effect of patients not on GDMT compared to GDMT with concurrent medication fills was more pronounced, with a 37% increased mortality risk.
conclusionIn a real-world population of HFrEF patients, inadequate GDMT confers a 29% excess mortality risk over the 2-year follow-up.
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Registered trials
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