{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:45:36Z","timestamp":1769085936227,"version":"3.49.0"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":2392,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,7,3]],"date-time":"2019-07-03T00:00:00Z","timestamp":1562112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Hutter Family Professorship in Cardiology"},{"name":"Dennis and Marilyn Barry Fellowship in Cardiology"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In this observational analysis from the Practice Innovation and Clinical Excellence Registry\u00ae, we examined changes in guideline-directed medical therapies relative to changes in symptom severity in ambulatory patients with heart failure with reduced ejection fraction, finding change in medication more often occurring when patients were changing their New York Heart Association symptom severity, rather than during periods of stable symptoms. Additionally, despite being available for a year during the time of our analysis, the use of sacubitril\/valsartan was extremely low, and most often added in the context of worsening symptoms, not how this drug was studied and not how the guidelines articulate its use.<\/jats:p>","DOI":"10.1002\/ehf2.12480","type":"journal-article","created":{"date-parts":[[2019,7,3]],"date-time":"2019-07-03T07:08:35Z","timestamp":1562137715000},"page":"1085-1087","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Alteration of Medical Therapy in Patients with Heart Failure Relative to Change in Symptom Severity"],"prefix":"10.1093","volume":"6","author":[{"given":"Nasrien E.","family":"Ibrahim","sequence":"first","affiliation":[{"name":"Cardiology Division, Massachusetts General Hospital , 55 Fruit Street, GRB-800, Boston, MA, 02114 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Song","sequence":"additional","affiliation":[{"name":"Baim Institute for Clinical Research , Brookline, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher P.","family":"Cannon","sequence":"additional","affiliation":[{"name":"Cardiology Division, Brigham and Women's Hospital , Boston, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gheorghe","family":"Doros","sequence":"additional","affiliation":[{"name":"Baim Institute for Clinical Research , Brookline, MA ,","place":["USA"]},{"name":"Boston University , Boston, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Russo","sequence":"additional","affiliation":[{"name":"Novartis , Boston, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo","family":"Ponirakis","sequence":"additional","affiliation":[{"name":"American College of Cardiology , Washington, DC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Alexanian","sequence":"additional","affiliation":[{"name":"American College of Cardiology , Washington, DC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"James L.","family":"Januzzi","sequence":"additional","affiliation":[{"name":"Cardiology Division, Massachusetts General Hospital , 55 Fruit Street, GRB-800, Boston, MA, 02114 ,","place":["USA"]},{"name":"Baim Institute for Clinical Research , Brookline, MA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,7,3]]},"reference":[{"key":"2026012115085575700_ehf212480-bib-0001","first-page":"137","article-title":"2017 ACC\/AHA\/HFSA focused 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","volume":"2017","author":"Yancy","journal-title":"Circulation"},{"key":"2026012115085575700_ehf212480-bib-0002","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1016\/S0140-6736(09)61913-9","article-title":"Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial","volume":"374","author":"Konstam","year":"2009","journal-title":"Lancet"},{"key":"2026012115085575700_ehf212480-bib-0003","doi-asserted-by":"crossref","first-page":"2312","DOI":"10.1161\/01.CIR.100.23.2312","article-title":"Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure","volume":"100","author":"Packer","year":"1999","journal-title":"Circulation"},{"key":"2026012115085575700_ehf212480-bib-0004","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1016\/S0140-6736(99)04440-2","article-title":"Effect of metoprolol CR\/XL in chronic heart failure: Metoprolol CR\/XL Randomised Intervention Trial in-Congestive Heart Failure (MERIT-HF)","volume":"353","author":"Group M-HS","year":"1999","journal-title":"Lancet"},{"key":"2026012115085575700_ehf212480-bib-0005","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1016\/j.jacc.2016.05.011","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","volume":"68","author":"Yancy","journal-title":"J Am Coll Cardiol"},{"key":"2026012115085575700_ehf212480-bib-0006","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur Heart J"},{"key":"2026012115085575700_ehf212480-bib-0007","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jacc.2017.11.025","article-title":"2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction","volume":"71","author":"Yancy","year":"2017","journal-title":"J Am Coll Cardiol"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ehf2.12480","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ehf2.12480","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/6\/5\/1085\/66136130\/eschf_6_5_1085.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/6\/5\/1085\/66136130\/eschf_6_5_1085.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T20:11:25Z","timestamp":1769026285000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/6\/5\/1085\/8403515"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,3]]},"references-count":7,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,7,3]]},"published-print":{"date-parts":[[2019,10,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.12480","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,10]]},"published":{"date-parts":[[2019,7,3]]},"assertion":[{"value":"2019-03-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}