{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T02:25:26Z","timestamp":1793499926239,"version":"4.5.0"},"reference-count":68,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2018,12,10]],"date-time":"2018-12-10T00:00:00Z","timestamp":1544400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2018,12,10]],"date-time":"2018-12-10T00:00:00Z","timestamp":1544400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Multiple drug classes have shown incremental benefits in heart failure with reduced ejection fraction. Most of these trials were designed to achieve specific doses of the investigational agent. Clinical practice guidelines recommend using the same target dosing of therapies, as tolerated. However, with the increasing number of available therapies, clinicians face the challenge of simultaneously using several drugs, achieving target doses, and managing side effects that are often overlapping. Blood pressure, renal function, hyperkalaemia, and other factors may impede achieving target doses of all medications, leaving clinicians with dilemmas as to how to sequence and dose these various classes of drugs. The guideline-directed eligibility for certain drugs and devices requires stability on maximally tolerated doses of background therapies. However, significant variability exists in dosing achieved in clinical practice. We discuss the existing background data regarding the doses of heart failure medications in clinical trials and in practice, and provide recommendations on how to navigate this complex therapeutic decision-making.<\/jats:p>","DOI":"10.1002\/ejhf.1351","type":"journal-article","created":{"date-parts":[[2018,12,10]],"date-time":"2018-12-10T07:04:37Z","timestamp":1544425477000},"page":"286-296","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":81,"title":["Medication Dosing for Heart Failure with Reduced Ejection Fraction \u2014 Opportunities and Challenges"],"prefix":"10.1093","volume":"21","author":[{"given":"Catherine N.","family":"Marti","sequence":"first","affiliation":[{"name":"Piedmont Heart Institute and University of Georgia , Athens, GA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles , Los Angeles, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan D.","family":"Anker","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charit\u00e9 University Medicine , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clyde","family":"Yancy","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Northwestern University Feinberg School of Medicine , Chicago, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muthiah","family":"Vaduganathan","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Greene","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine , Durham, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center and George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James L.","family":"Januzzi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, and the Baim Institute for Clinical Research , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Gheorghiade","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Northwestern University Feinberg School of Medicine , Chicago, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Filippatos","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Athens University Hospital , Attikon ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Mississippi Medical Center , Jackson, MS ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,12,10]]},"reference":[{"key":"2026011721295489600_ejhf1351-bib-0001","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1016\/0735-1097(95)00012-S","article-title":"Carvedilol improves left ventricular function and symptoms in chronic heart failure: a double-blind randomized study","volume":"25","author":"Olsen","year":"1995","journal-title":"J Am Coll Cardiol"},{"key":"2026011721295489600_ejhf1351-bib-0002","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1161\/01.CIR.94.11.2807","article-title":"Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. 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