{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:50:43Z","timestamp":1788562243827,"version":"build-2803163510"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":892,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T00:00:00Z","timestamp":1687824000000},"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":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To investigate whether a heart failure (HF) hospitalization is associated with initiation\/discontinuation of guideline-directed medical HF therapy (GDMT) and consequent outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Among patients in the Swedish HF registry with an ejection fraction &amp;lt;50% enrolled in 2009\u20132018, initiation\/discontinuation of GDMT was investigated by assessing dispensations of GDMT in those with versus without a HF hospitalization. Of 14\u2009737 patients, 6893 (47%) were enrolled when hospitalized for HF. Initiation of GDMT was more likely than discontinuation following a HF hospitalization compared to a control group of patients without a HF hospitalization (odds ratio range 2.1\u20134.0 vs. 1.4\u20131.6 for the individual medications), although the proportion of patients not on GDMT was still high (8.1\u201344.0%). Key patient characteristics triggering less use of GDMT (i.e. less initiation or more discontinuation) were older age and worse renal function. Following a HF hospitalization, initiation of renin\u2013angiotensin system inhibitors\/angiotensin receptor\u2013neprilysin inhibitors or beta-blockers was associated with lower and their discontinuation with higher mortality risk, but no association with mortality was observed for initiation\/discontinuation of mineralocorticoid receptor antagonists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Following a HF hospitalization, initiation of GDMT was more likely than discontinuation, although still limited. Perceived or actual low tolerance were barriers to GDMT implementation. Early re-\/initiation of GDMT was associated with better survival. Our findings represent a call for further implementing the current guideline recommendation for an early re-\/initiation of GDMT following a HF hospitalization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2928","type":"journal-article","created":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T02:24:45Z","timestamp":1686795885000},"page":"1132-1144","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Association Between a Hospitalization for Heart Failure and the Initiation\/Discontinuation of Guideline-Recommended Treatments: An Analysis from the Swedish Heart Failure Registry"],"prefix":"10.1093","volume":"25","author":[{"given":"Benedikt","family":"Schrage","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"University Heart and Vascular Centre Hamburg, Department of Cardiology and German Center for Cardiovascular Research (DZHK), partner site Hamburg\/L\u00fcbeck\/Kiel , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars H.","family":"Lund","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Heart and Vascular and Neuro Theme, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Benson","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frieder","family":"Braunschweig","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Heart and Vascular and Neuro Theme, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Pedro","family":"Ferreira","sequence":"additional","affiliation":[{"name":"INSERM, Centre d'Investigations Cliniques Plurith\u00e9matique 1433, Universit\u00e9 de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Dahlstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe M.C.","family":"Rosano","sequence":"additional","affiliation":[{"name":"Centre for Clinical and Basic Research, IRCCS San Raffaele Roma , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7732-0887","authenticated-orcid":false,"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Heart and Vascular and Neuro Theme, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,6,27]]},"reference":[{"key":"2026010913101614300_ejhf2928-bib-0001","doi-asserted-by":"crossref","first-page":"7","DOI":"10.15420\/cfr.2016:25:2","article-title":"Global public health burden of heart failure","volume":"3","author":"Savarese","year":"2017","journal-title":"Card Fail Rev"},{"key":"2026010913101614300_ejhf2928-bib-0002","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1038\/s41569-021-00605-5","article-title":"Heart failure with mid-range or mildly reduced ejection fraction","volume":"19","author":"Savarese","year":"2022","journal-title":"Nat Rev Cardiol"},{"key":"2026010913101614300_ejhf2928-bib-0003","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"24","author":"McDonagh","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026010913101614300_ejhf2928-bib-0004","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1002\/ejhf.2477","article-title":"Association between dosing and combination use of medications and outcomes in heart failure with reduced ejection fraction: Data from the Swedish Heart Failure Registry","volume":"24","author":"D'Amario","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026010913101614300_ejhf2928-bib-0005","doi-asserted-by":"crossref","first-page":"2573","DOI":"10.1093\/eurheartj\/ehac210","article-title":"Accelerated and personalized therapy for heart failure with reduced ejection fraction","volume":"43","author":"Shen","year":"2022","journal-title":"Eur Heart J"},{"key":"2026010913101614300_ejhf2928-bib-0006","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/S0140-6736(20)30748-0","article-title":"Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: A comparative analysis of three randomised controlled trials","volume":"396","author":"Vaduganathan","year":"2020","journal-title":"Lancet"},{"key":"2026010913101614300_ejhf2928-bib-0007","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1002\/ejhf.2271","article-title":"Heart failure drug titration, discontinuation, mortality and heart failure hospitalization risk: A multinational observational study (US, UK and Sweden)","volume":"23","author":"Savarese","year":"2021","journal-title":"Eur J Heart Fail"},{"key":"2026010913101614300_ejhf2928-bib-0008","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1002\/ejhf.1182","article-title":"Factors associated with underuse of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: An analysis of 11 215 patients from the Swedish Heart Failure Registry","volume":"20","author":"Savarese","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"2026010913101614300_ejhf2928-bib-0009","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1002\/ehf2.13848","article-title":"Patient profile and outcomes associated with follow-up in specialty vs. primary care in heart failure","volume":"9","author":"Lindberg","year":"2022","journal-title":"ESC Heart Fail"},{"key":"2026010913101614300_ejhf2928-bib-0010","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/j.jacc.2018.11.049","article-title":"Clinical course of patients with worsening heart failure with reduced ejection fraction","volume":"73","author":"Butler","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2026010913101614300_ejhf2928-bib-0011","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1080\/03009734.2018.1490831","article-title":"The Swedish Heart Failure Registry: A living, ongoing quality assurance and research in heart failure","volume":"124","author":"Savarese","year":"2019","journal-title":"Ups J Med Sci"},{"key":"2026010913101614300_ejhf2928-bib-0012","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":"2026010913101614300_ejhf2928-bib-0013","doi-asserted-by":"crossref","first-page":"2388","DOI":"10.1093\/eurheartj\/ehn309","article-title":"ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)","volume":"29","author":"Dickstein","year":"2008","journal-title":"Eur Heart J"},{"key":"2026010913101614300_ejhf2928-bib-0014","first-page":"1","article-title":"mice: Multivariate imputation by chained equations in R","volume":"45","author":"van Buuren","year":"2011","journal-title":"J Stat Softw"},{"key":"2026010913101614300_ejhf2928-bib-0015","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1136\/heartjnl-2020-317216","article-title":"Lower socioeconomic status predicts higher mortality and morbidity in patients with heart failure","volume":"107","author":"Schrage","year":"2021","journal-title":"Heart"},{"key":"2026010913101614300_ejhf2928-bib-0016","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1016\/j.jacc.2019.02.015","article-title":"Titration of medical therapy for heart failure with reduced ejection fraction","volume":"73","author":"Greene","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2026010913101614300_ejhf2928-bib-0017","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jchf.2020.08.017","article-title":"Heart failure hospitalization and guideline-directed prescribing patterns among heart failure with reduced ejection fraction patients","volume":"9","author":"Srivastava","year":"2021","journal-title":"JACC Heart Fail"},{"key":"2026010913101614300_ejhf2928-bib-0018","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1002\/ejhf.2252","article-title":"Treatment patterns and clinical outcomes among patients &lt;65\u2009years with a worsening heart failure event","volume":"23","author":"Butler","year":"2021","journal-title":"Eur J Heart Fail"},{"key":"2026010913101614300_ejhf2928-bib-0019","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/j.cardfail.2022.02.011","article-title":"Medical therapy during hospitalization for heart failure with reduced ejection fraction: The VICTORIA registry","volume":"28","author":"Greene","year":"2022","journal-title":"J Card Fail"},{"key":"2026010913101614300_ejhf2928-bib-0020","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1038\/nrneph.2012.281","article-title":"Improving the efficacy of RAAS blockade in patients with chronic kidney disease","volume":"9","author":"Lambers Heerspink","year":"2013","journal-title":"Nat Rev Nephrol"},{"key":"2026010913101614300_ejhf2928-bib-0021","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.jchf.2018.02.004","article-title":"Renal effects and associated outcomes during angiotensin-neprilysin inhibition in heart failure","volume":"6","author":"Damman","year":"2018","journal-title":"JACC Heart Fail"},{"key":"2026010913101614300_ejhf2928-bib-0022","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1002\/ejhf.2483","article-title":"Use of evidence-based therapy in heart failure with reduced ejection fraction across age strata","volume":"24","author":"Stolfo","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026010913101614300_ejhf2928-bib-0023","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.116.004675","article-title":"Initiation, continuation, or withdrawal of angiotensin-converting enzyme inhibitors\/angiotensin receptor blockers and outcomes in patients hospitalized with heart failure with reduced ejection fraction","volume":"6","author":"Gilstrap","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2026010913101614300_ejhf2928-bib-0024","doi-asserted-by":"crossref","first-page":"2462","DOI":"10.1016\/j.jacc.2006.03.030","article-title":"Beta-blocker use and outcomes among hospitalized heart failure patients","volume":"47","author":"Butler","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"2026010913101614300_ejhf2928-bib-0025","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1001\/jamacardio.2021.0496","article-title":"Simultaneous or rapid sequence initiation of quadruple medical therapy for heart failure-optimizing therapy with the need for speed","volume":"6","author":"Greene","year":"2021","journal-title":"JAMA Cardiol"},{"key":"2026010913101614300_ejhf2928-bib-0026","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.118.011737","article-title":"Nurse-led heart failure clinics are associated with reduced mortality but not heart failure hospitalization","volume":"8","author":"Savarese","year":"2019","journal-title":"J Am Heart Assoc"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/25\/7\/1132\/65494542\/eurjhf_25_7_1132.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/25\/7\/1132\/65494542\/eurjhf_25_7_1132.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T18:12:52Z","timestamp":1767982372000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjhf\/article\/25\/7\/1132\/8341875"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,27]]},"references-count":26,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,6,27]]},"published-print":{"date-parts":[[2023,7,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ejhf.2928","relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,7]]},"published":{"date-parts":[[2023,6,27]]},"assertion":[{"value":"2022-12-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}