The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index.
Medical Therapy for Heart Failure With Reduced Ejection Fraction
Open accessAbstract
BACKGROUND Guidelines strongly recommend patients with heart failure with reduced ejection fraction (HFrEF) be treated with multiple medications proven to improve clinical outcomes, as tolerated. The degree to which gaps in medication use and dosing persist in contemporary outpatient practice is unclear. OBJECTIVES This study sought to characterize patterns and factors associated with use and dose of HFrEF medications in current practice. METHODS The CHAMP-HF (Change the Management of Patients with Heart Failure) registry included outpatients in the United States with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA). Patient-level factors associated with medication use were examined. RESULTS Overall, 3,518 patients from 150 primary care and cardiology practices were included. Mean age was 66 ± 13 years, 29% were female, and mean EF was 29 ± 8%. Among eligible patients, 27%, 33%, and 67% were not prescribed ACEI/ARB/ARNI, beta-blocker, and MRA therapy, respectively. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (17%), ARNI (14%), and beta-blocker (28%), whereas most patients were receiving target doses of MRA therapy (77%). Among patients eligible for all classes of medication, 1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, and MRA. In adjusted models, older age, lower blood pressure, more severe functional class, renal insufficiency, and recent HF hospitalization generally favored lower medication utilization or dose. Social and economic characteristics were not independently associated with medication use or dose. CONCLUSIONS In this contemporary outpatient HFrEF registry, significant gaps in use and dose of guideline-directed medical therapy remain. Multiple clinical factors were associated with medication use and dose prescribed. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.
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Cites
2013 ACCF/AHA Guideline for the Management of Heart Failure
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T., Januzzi, J. L., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.05.019 · Cited by 12,536
Self-citationTrends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction
Owan, T. E., Hodge, D. O., Herges, R. M., Jacobsen, S. J., Roger, V. L., & Redfield, M. M. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa052256 · Cited by 4,191
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., Drazner, M. H., Filippatos, G. S., Fonarow, G. C., Givertz, M. M., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.04.025 · Cited by 3,418
Self-citationSteinberg, B. A., Zhao, X., Heidenreich, P. A., Peterson, E. D., Bhatt, D. L., Cannon, C. P., Hernandez, A. F., & Fonarow, G. C. (2012) · Circulation · doi:10.1161/circulationaha.111.080770 · Cited by 775
Self-citationFelker, G. M., Anstrom, K. J., Adams, K. F., Ezekowitz, J. A., Fiuzat, M., Houston-Miller, N., Januzzi, J. L., Mark, D. B., Piña, I. L., Passmore, G., et al. (2017) · JAMA · doi:10.1001/jama.2017.10565 · Cited by 548
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Self-citationRuppar, T. M., Cooper, P. S., Mehr, D. R., Delgado, J. M., & Dunbar‐Jacob, J. M. (2016) · Journal of the American Heart Association · doi:10.1161/jaha.115.002606 · Cited by 415
Ouwerkerk, W., Voors, A. A., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G., van der Harst, P., Hillege, H. L., Lang, C. C., ter Maaten, J. M., et al. (2017) · European Heart Journal · doi:10.1093/eurheartj/ehx026 · Cited by 404
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The American Heart Association get with the guidelines program
Smaha, L. A. (2004) · American Heart Journal · doi:10.1016/j.ahj.2004.09.015 · Cited by 292
Research works printed but not linked: 1
- Khan, 2008, Managed care interventions for improving outcomes in acute heart failure syndromes, Am J Manag Care, 14, S273
Cited by
Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001123 · Cited by 8,300
Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001052 · Cited by 5,987
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001063 · Cited by 4,922
Self-citation2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., et al. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.12.012 · Cited by 2,862
Self-citationMartin, S. S., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Barone Gibbs, B., Beaton, A. Z., Boehme, A. K., et al. (2024) · Circulation · doi:10.1161/cir.0000000000001209 · Cited by 2,800
Metadata
- Authors
- Greene, S. J., Butler, J., Albert, N. M., DeVore, A. D., Sharma, P. P., Duffy, C. I., Hill, C. L., McCague, K., Mi, X., Patterson, J. H., Spertus, J. A., Thomas, L., Williams, F. B., Hernandez, A. F., & Fonarow, G. C.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2018-07
- Volume
- 72
- Issue
- 4
- Pages
- 351-366
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2883756867
- Cited by
- 1,314
- References
- 22
- FWCI
- 61.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (vor, 388 d)
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- Greene, S. J., Butler, J., Albert, N. M., DeVore, A. D., Sharma, P. P., Duffy, C. I., Hill, C. L., McCague, K., Mi, X., Patterson, J. H., Spertus, J. A., Thomas, L., Williams, F. B., Hernandez, A. F., & Fonarow, G. C. (2018). Medical Therapy for Heart Failure With Reduced Ejection Fraction. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2018.04.070
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