{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T23:15:09Z","timestamp":1786576509103,"version":"build-2736575974"},"reference-count":55,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,2,25]],"date-time":"2024-02-25T00:00:00Z","timestamp":1708819200000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Kidney dysfunction (KD) is a main limiting factor of applying guideline\u2010directed medical therapy (GDMT) and reaching the recommended target doses (TD) in heart failure (HF) with reduced ejection fraction (HFrEF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>We aimed to assess the success of optimization, long\u2010term applicability, and adherence of neurohormonal antagonist triple therapy (TT:RASi [ACEi\/ARB\/ARNI]\u2009+\u2009\u03b2B\u2009+\u2009MRA) according to the KD after a HF hospitalization and to investigate its impact on prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The data of 247 real\u2010world, consecutive patients were analyzed who were hospitalized in 2019\u22122021 for HFrEF and then were followed\u2010up for 1 year. The application and the ratio of reached TD of TT at hospital discharge and at 1 year were assessed comparing KD categories (eGFR: \u226590, 60\u221289, 45\u221259, 30\u221244, &lt;30\u2009mL\/min\/1.73\u2009m<jats:sup>2<\/jats:sup>). Moreover, 1\u2010year all\u2010cause mortality and rehospitalization rates in KD subgroups were investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Majority of the patients received TT at hospital discharge (77%) and at 1 year (73%). More severe KD led to a lower application ratio (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05) of TT (92%, 88%, 80%, 73%, 31%) at discharge and at 1 year (81%, 76%, 76%, 68%, 40%). Patients with more severe KD were less likely (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05) to receive TD of MRA (81%, 68%, 78%, 61%, 52%) at discharge and a RASi (53%, 49%, 45%, 21%, 27%) at 1 year.<\/jats:p><jats:p>One\u2010year all\u2010cause mortality (14%, 15%, 16%, 33%, 48%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), the ratio of all\u2010cause rehospitalizations (30%, 35%, 40%, 43%, 52%, <jats:italic>p<\/jats:italic>\u2009=\u2009.028), and rehospitalizations for HF (8%, 13%, 18%, 20%, 38%, <jats:italic>p<\/jats:italic>\u2009=\u2009.001) were significantly higher in more severe KD categories.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>KD unfavorably affects the application of TT in HFrEF, however poorer mortality and rehospitalization rates among them highlight the role of the conscious implementation and up\u2010titration of GDMT.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.24244","type":"journal-article","created":{"date-parts":[[2024,2,25]],"date-time":"2024-02-25T14:55:35Z","timestamp":1708872935000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The effect of kidney function on guideline\u2010directed medical therapy implementation and prognosis in heart failure with reduced ejection fraction"],"prefix":"10.1002","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5024-2820","authenticated-orcid":false,"given":"Fanni","family":"B\u00e1nfi\u2010Bacs\u00e1rdi","sequence":"first","affiliation":[{"name":"Department of Cardiology Central Hospital of Northern Pest \u2010 Military Hospital Budapest Hungary"},{"name":"Department of Adult Cardiology Gottsegen National Cardiovascular Center Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e1vid","family":"Pilecky","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology Gottsegen National Cardiovascular Center Budapest Hungary"},{"name":"Doctoral School of Clinical Medicine University of Szeged Szeged Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1t\u00e9","family":"V\u00e1mos","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Division, Cardiology Center, Department of Internal Medicine University of Szeged Szeged Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsuzsanna","family":"Majoros","sequence":"additional","affiliation":[{"name":"Department of Cardiology Central Hospital of Northern Pest \u2010 Military Hospital Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e1bor M\u00e1rton","family":"T\u00f6r\u00f6k","sequence":"additional","affiliation":[{"name":"Department of Cardiology Central Hospital of Northern Pest \u2010 Military Hospital Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T\u00fcnde D\u00f3ra","family":"Bors\u00e1nyi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Central Hospital of Northern Pest \u2010 Military Hospital Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikl\u00f3s","family":"D\u00e9k\u00e1ny","sequence":"additional","affiliation":[{"name":"Department of Cardiology Central Hospital of Northern Pest \u2010 Military Hospital Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bal\u00e1zs","family":"Solymossi","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology Gottsegen National Cardiovascular Center Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"Andr\u00e9ka","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology Gottsegen National Cardiovascular Center Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1286-6576","authenticated-orcid":false,"given":"G\u00e1bor Zolt\u00e1n","family":"Duray","sequence":"additional","affiliation":[{"name":"Department of Cardiology Central Hospital of Northern Pest \u2010 Military Hospital Budapest Hungary"},{"name":"Heart and Vascular Center Semmelweis University Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00f3bert G\u00e1bor","family":"Kiss","sequence":"additional","affiliation":[{"name":"Department of Cardiology Central Hospital of Northern Pest \u2010 Military Hospital Budapest Hungary"},{"name":"Heart and Vascular Center Semmelweis University Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"No\u00e9mi","family":"Nyolczas","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology Gottsegen National Cardiovascular Center Budapest Hungary"},{"name":"Doctoral School of Clinical Medicine University of Szeged Szeged Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0821-484X","authenticated-orcid":false,"given":"Bal\u00e1zs","family":"Muk","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology Gottsegen National Cardiovascular Center Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.05.002"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.04.070"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx026"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.55119"},{"key":"e_1_2_10_7_1","unstructured":"United States Renal Data System.USRDS annual data report: epidemiology of kidney disease in the United States. National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases Bethesda MD.2022."},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfab290"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.05.027"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht386"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.052792"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199108013250501"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009492"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000035653.72855.BF"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409077"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1911303"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2022190"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)11181-9"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2009.12.016"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2008.05.028"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.122.321748"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11082243"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2206"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2020050682"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5402.177"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/kisup.2012.73"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1697"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.566"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1556\/650.2017.30671"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2471"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.111.963256"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.02.009"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.058910"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.05.019"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2024816"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2025845"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915928"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2025797"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2022.02.011"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2023.04.015"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2620"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.recesp.2023.05.004"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2016.03.002"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2210639"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfab026"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.02.022"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjco.2022.06.007"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2022.08.009"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1159\/000528505"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-020-09979-z"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ihj.2022.06.005"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.813"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcha.2022.101159"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43044-023-00342-9"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy005"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.24244","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T10:11:20Z","timestamp":1713175880000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.24244"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":55,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1002\/clc.24244"],"URL":"https:\/\/doi.org\/10.1002\/clc.24244","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"value":"0160-9289","type":"print"},{"value":"1932-8737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2]]},"assertion":[{"value":"2023-10-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e24244"}}