{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T10:54:00Z","timestamp":1782730440175,"version":"3.54.5"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":1108,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["20\/1819"],"award-info":[{"award-number":["20\/1819"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["20\/1819"],"award-info":[{"award-number":["20\/1819"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>In symptomatic patients with heart failure and reduced ejection fraction (HFrEF), recent international guidelines recommend initiating four major therapeutic classes rather than sequential initiation. It remains unclear how this change in guidelines is perceived by practicing cardiologists versus heart failure (HF) specialists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>An independent academic web-based survey was designed by a group of HF specialists and posted by email and through various social networks to a broad community of cardiologists worldwide 1\u2009year after the publication of the latest European HF guidelines. Overall, 615 cardiologists (38 [32\u201347] years old, 63% male) completed the survey, of which 58% were working in a university hospital and 26% were HF specialists. The threshold to define HFrEF was \u226440% for 61% of the physicians. Preferred drug prescription for the sequential approach was angiotensin-converting enzyme inhibitors or angiotensin receptor\u2013neprilysin inhibitors first (74%), beta-blockers second (55%), mineralocorticoid receptor antagonists third (52%), and sodium\u2013glucose cotransporter 2 inhibitors (53%) fourth. Eighty-four percent of participants felt that starting all four classes was feasible within the initial hospitalization, and 58% felt that titration is less important than introducing a new class. Age, status in training, and specialization in HF field were the principal characteristics that significantly impacted the answers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a broad international cardiology community, the \u2018historical approach\u2019 to HFrEF therapies remains the preferred sequencing approach. However, accelerated introduction and uptitration are also major treatment goals. Strategy trials in treatment guidance are needed to further change practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2743","type":"journal-article","created":{"date-parts":[[2022,11,20]],"date-time":"2022-11-20T23:30:00Z","timestamp":1668987000000},"page":"213-222","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Sequencing and Titrating Approach of Therapy in Heart Failure with Reduced Ejection Fraction Following the 2021 European Society of Cardiology Guidelines: An International Cardiology Survey"],"prefix":"10.1093","volume":"25","author":[{"given":"Charles","family":"Fauvel","sequence":"first","affiliation":[{"name":"CHU ROUEN, Department of Cardiology, FHU Carnaval, Rouen University Hospital , Rouen ,","place":["France"]},{"name":"Internal Medicine Department, Cardiovascular Medicine Section, Wexner Medical Center, The Ohio State University , Columbus, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Bonnet","sequence":"additional","affiliation":[{"name":"H\u00f4pital Cardiologique Haut-L\u00e9v\u00eaque, Centre Hospitalier Universitaire de Bordeaux, Unit\u00e9 M\u00e9dico-Chirurgical de Valvulopathies et Cardiomyopathies , Pessac ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfried","family":"Mullens","sequence":"additional","affiliation":[{"name":"Ziekenhuis Oost-Limburg A.V , Genk ,","place":["Belgium"]},{"name":"Hasselt University , Hasselt ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara Ines Saldarriaga","family":"Giraldo","sequence":"additional","affiliation":[{"name":"Pontificia Bolivariana University, CardioVID Clinic , Medell\u00edn ,","place":["Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja Zupan","family":"Me\u017enar","sequence":"additional","affiliation":[{"name":"Cardiology Department, UMC Ljubljana , Ljubljana ,","place":["Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Barasa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Glostrup Hospital , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariya","family":"Tokmakova","sequence":"additional","affiliation":[{"name":"Cardiology Department, UMHAT \u2018Sv. 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