{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T20:10:45Z","timestamp":1787947845649,"version":"build-2784847793"},"reference-count":13,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T00:00:00Z","timestamp":1627948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006520","name":"Edwards Lifesciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006520","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To estimate the prevalence of guideline\u2010directed medical therapy (GDMT) in commercially insured US patients with heart failure with reduced ejection fraction (HFrEF) and examine the effect of GDMT on all\u2010cause mortality. GDMT for HFrEF includes pharmacologic therapies such as \u03b2\u2010blockers (BB), angiotensin\u2010converting enzyme inhibitors (ACE\u2010I), angiotensin receptor blockers (ARB), angiotensin receptor\u2010neprilysin (ARNI), mineralocorticoid receptor antagonists (MRA), and sodium\u2010glucose cotransporter inhibitors to reduce morbidity and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients in the Optum Integrated File from 2007 to 2019Q3, \u226518\u2009years, with history of HFrEF, were identified. Patients prescribed both a BB and either an ACE\u2010I, ARB, or ARNI during 6\u2010month post\u2010diagnosis 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\u2009years was assessed with a Cox regression model accounting for baseline demographics, comorbidities, and diuretic use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study identified 14\u2009880 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\u20131.40); <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In a real\u2010world population of HFrEF patients, inadequate GDMT confers a 29% excess mortality risk over the 2\u2010year follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.23664","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T07:01:00Z","timestamp":1627974060000},"page":"1192-1198","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Mortality and <scp>guideline\u2010directed<\/scp> medical therapy in <scp>real\u2010world<\/scp> heart failure patients with reduced ejection fraction"],"prefix":"10.1002","volume":"44","author":[{"given":"Peter A.","family":"McCullough","sequence":"first","affiliation":[{"name":"Texas A &amp; M College of Medicine  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirsch S.","family":"Mehta","sequence":"additional","affiliation":[{"name":"San Diego Cardiac Center SHARP Healthcare  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin M.","family":"Barker","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2129-3319","authenticated-orcid":false,"given":"Joanna","family":"Van Houten","sequence":"additional","affiliation":[{"name":"Edwards Lifesciences  Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Mollenkopf","sequence":"additional","affiliation":[{"name":"Edwards Lifesciences  Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0723-585X","authenticated-orcid":false,"given":"Candace","family":"Gunnarsson","sequence":"additional","affiliation":[{"name":"Gunnarsson Consulting  Jupiter Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ryan","sequence":"additional","affiliation":[{"name":"MPR Consulting  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David P.","family":"Cork","sequence":"additional","affiliation":[{"name":"Scripps Clinic  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,8,3]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"e139","article-title":"Heart disease and stroke statistics \u2010 2020 update: a report from the American Heart Association","volume":"14","author":"Virani SS","year":"2020","journal-title":"Circulation"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.08.074"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000509"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.03.478"},{"key":"e_1_2_10_6_1","unstructured":"Optum Inc. Eden Prairie MN 2017.Clinformatics\u00ae Data Marthttps:\/\/www.optum.com\/content\/dam\/optum3\/optum\/en\/resources\/whitepapers\/clinformatics\u2010data\u2010mart.pdf."},{"key":"e_1_2_10_7_1","first-page":"w14295","article-title":"Medical therapy of heart failure with reduced ejection fraction: current evidence and new developments","volume":"146","author":"Naegele M","year":"2016","journal-title":"Swiss Med Wkly"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409077"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.12.1319"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2016.22.5.561"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.04.070"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.08.075"},{"key":"e_1_2_10_13_1","volume-title":"StatPearls [Internet]","author":"Farzam K","year":"2020"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.06.011"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.23664","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/clc.23664","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.23664","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T22:05:57Z","timestamp":1693346757000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.23664"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,3]]},"references-count":13,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1002\/clc.23664"],"URL":"https:\/\/doi.org\/10.1002\/clc.23664","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"value":"0160-9289","type":"print"},{"value":"1932-8737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,3]]},"assertion":[{"value":"2021-04-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}