{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:02:30Z","timestamp":1790791350519,"version":"4.1.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,4,3]],"date-time":"2022-04-03T00:00:00Z","timestamp":1648944000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>In older patients, guideline\u2010directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (&lt;40%; HFrEF) is not contraindicated, but adherence to guidelines is limited. We investigated the implementation of GDMT in HFrEF across different age strata in a large nationwide cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients with HFrEF and HF duration \u22653\u2009months registered in the Swedish HF Registry between 2000\u20132018 were analysed according to age. Multivariable logistic and multinomial regressions were fitted to investigate factors associated with underuse\/underdosing. Of 27\u2009430 patients, 31% were\u2009&lt;70\u2009years old, 34% 70\u201379\u2009years old, and 35% \u226580\u2009years old. Use of treatments progressively decreased with increasing age. Use of renin\u2013angiotensin system\/angiotensin receptor\u2013neprilysin inhibitors, beta\u2010blockers and mineralocorticoid receptor antagonists was 80%, 88% and 35% in age\u2009\u226580\u2009years; 90%, 93% and 47% in age 70\u201379\u2009years; and 95%, 95% and 54% in age\u2009&lt;70\u2009years, respectively. Among patients with an indication, use of implantable cardioverter defibrillator and cardiac resynchronization therapy (CRT) was 7% and 23% in age\u2009\u2265\u200980\u2009years; 22% and 42% in age 70\u201379\u2009years; and 29% and 50% in age\u2009&lt;70\u2009years, respectively. Older patients were less likely treated with target doses or combinations of HF medications. Except for CRT, after extensive adjustments, age was inversely associated with the likelihood of GDMT use and target dose achievement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In HFrEF, gaps persist in the use of medications and devices. In disagreement with current recommendations, older patients remain undertreated. Improving strategies and a more individualized approach for implementing use of GDMT in HFrEF are required, particularly in older patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2483","type":"journal-article","created":{"date-parts":[[2022,3,12]],"date-time":"2022-03-12T09:29:47Z","timestamp":1647077387000},"page":"1047-1062","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":85,"title":["Use of evidence\u2010based therapy in heart failure with reduced ejection fraction across age strata"],"prefix":"10.1093","volume":"24","author":[{"given":"Davide","family":"Stolfo","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine Karolinska Institutet  Stockholm Sweden"},{"name":"Cardiothoracovascular Department and University of Trieste  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars 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