{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:15:27Z","timestamp":1787584527606,"version":"build-2736575974"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":768,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T00:00:00Z","timestamp":1696550400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Swedish Heart Lung Foundation","award":["20210247"],"award-info":[{"award-number":["20210247"]}]},{"DOI":"10.13039\/501100009240","name":"Swedish Association of Local Authorities and Regions","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009240","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009240","name":"Sveriges Kommuner och Landsting","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009240","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>How different degrees of adherence to guideline-directed medical therapy (GDMT) affect mortality risk in patients with heart failure (HF) in a real-world clinical setting is poorly understood. This study sought to investigate how different levels of adherence to GDMT were associated with the risk of all-cause mortality in patients with HF across a spectrum of left ventricular ejection fractions (LVEFs) in a real-world clinical setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A total of 64 610 HF patients with no missing value of LVEF from the Swedish Heart Failure Registry were included in the study. Patients were divided according to different LVEFs (&amp;lt;30%, 30\u201339%, 40\u201349%, and\u226550%) and stratified by an adherence score (good, moderate, or poor) according to the triple, double, and single one usage of GDMT: angiotensin-converting enzyme inhibitors\/angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists. The outcome is time to all-cause mortality. The mean age of the whole cohort was 73.9 \u00b1 12.1 years, and the proportion of patients in LVEF &amp;lt; 30%, 30\u201339%, 40\u201349%, and\u226550% groups was 27.6%, 26.9%, 22.1%, and 23.3%, respectively. Patients with LVEF &amp;lt; 30% had the highest mortality rate, almost 20% higher than those with LVEF \u2265 50% {hazard ratio [HR] [95% confidence interval (CI)]: 0.80 [0.71\u20130.90], P &amp;lt; 0.001}. After treatment of GDMT with good adherence, patients with LVEF &amp;lt; 30% had similar mortality to those with LVEF \u2265 50% [HR (95% CI): 0.97 (0.86\u20131.10), P = 0.664]. However, the percentage of moderate or poor GDMT was alarmingly high, with good adherence only in 20% of the patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Good adherence to GDMT works best in patients with LVEF &amp;lt; 50%, whereas moderate adherence to GDMT varies in efficacy depending on the components of the drug combinations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.14358","type":"journal-article","created":{"date-parts":[[2023,10,7]],"date-time":"2023-10-07T07:11:01Z","timestamp":1696662661000},"page":"3656-3666","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Impact of Adherence to Guideline-Directed Therapy on Risk of Death in HF Patients Across an Ejection Fraction Spectrum"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1354-5053","authenticated-orcid":false,"given":"Xiaojing","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Cardiology, West China Hospital, Sichuan University , Chengdu, Sichuan ,","place":["China"]},{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital, Sichuan University , Chengdu, Sichuan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Dahlstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]},{"name":"Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,6]]},"reference":[{"key":"2026012113205715600_ehf214358-bib-0001","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":"2026012113205715600_ehf214358-bib-0002","doi-asserted-by":"crossref","first-page":"3599\u20133526","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2026012113205715600_ehf214358-bib-0003","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1002\/ejhf.887","article-title":"Physicians' guideline adherence is associated with better prognosis in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry","volume":"19","author":"Komajda","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2026012113205715600_ehf214358-bib-0004","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1093\/eurheartj\/ehx026","article-title":"Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study","volume":"38","author":"Ouwerkerk","year":"2017","journal-title":"Eur Heart J"},{"key":"2026012113205715600_ehf214358-bib-0005","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1093\/ageing\/afw119","article-title":"Age- and sex-related differences in use of guideline-recommended care and mortality among patients with incident heart failure in Denmark","volume":"45","author":"Nakano","year":"2016","journal-title":"Age Ageing"},{"key":"2026012113205715600_ehf214358-bib-0006","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.cardfail.2009.01.010","article-title":"Are there any significant differences between females and males in the management of heart failure? 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