{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:52:01Z","timestamp":1760575921563,"version":"build-2065373602"},"reference-count":21,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T00:00:00Z","timestamp":1721692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Am Coll Clin Pharm"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Guideline\u2010directed medical therapy (GDMT) has significantly improved outcomes in patients with heart failure with reduced ejection fraction. However, GDMT prescribing remains suboptimal. The purpose of this study was to survey cardiologists, internists, and pharmacists on their approach to GDMT prescribing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A survey containing 20 clinical vignettes of patients with heart failure with reduced ejection fraction was answered by 127 cardiologists, 68 internists, and 89 pharmacists. Each vignette presented options for adjusting GDMT. Responses were dichotomized to the answer of interest. A mixed\u2010effect model was used to calculate the odds of changing GDMT between pharmacists and physicians.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Pharmacists were more likely to make changes to GDMT compared with internists (92.1 vs. 82%; odds ratio [OR] 3.02 [1.50\u20136.06]; <jats:italic>p<\/jats:italic>\u2009=\u20090.002). In medically na\u00efve patients, pharmacists were more likely to initiate beta\u2010blockers than internists (45.4 vs. 32.0%; OR 2.19 [1.00\u20134.79], <jats:italic>p<\/jats:italic>\u2009=\u20090.049). Pharmacists were more likely than both internists and cardiologists to initiate mineralocorticoid receptor antagonists (34.4 vs. 11.5%; OR 4.95 [2.41\u201310.18]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 and 34.4 vs. 13.9%; OR 3.95 [2.16\u20137.21]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Pharmacists were more likely than both internists and cardiologists to titrate beta\u2010blockers (30.9 vs. 16.4%; OR 3.15 [1.92\u20135.19]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 and 30.9 vs. 22.0%; OR 1.88 [0.18\u20132.87]; <jats:italic>p<\/jats:italic>\u2009=\u20090.0030). Pharmacists were more likely than internists to titrate angiotensin receptor\u2010neprilysin inhibitors (61.8 vs. 34.1%; OR 3.54 [1.50\u20138.39]; <jats:italic>p<\/jats:italic>\u2009=\u20090.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The survey results show pharmacists were more likely to make any adjustments to GDMT than internists and cardiologists. Pharmacists prefer adding spironolactone and titrating beta\u2010blockers compared with cardiologists and internists. Compared with only internists, pharmacists were more likely to initiate beta\u2010blockers and titrate the dose of angiotensin receptor\u2010neprilysin inhibitor.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jac5.2013","type":"journal-article","created":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T20:05:07Z","timestamp":1721765107000},"page":"881-887","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differences in the approach to guideline\u2010directed medical therapy in patients with heart failure with reduced ejection fraction: A survey of cardiologists, internists, and pharmacists"],"prefix":"10.1002","volume":"7","author":[{"given":"Lana","family":"Alhashimi","sequence":"first","affiliation":[{"name":"College of Pharmacy University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Cordwin","sequence":"additional","affiliation":[{"name":"College of Pharmacy University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Guidi","sequence":"additional","affiliation":[{"name":"Medical School University of Michigan  Ann Arbor Michigan USA"},{"name":"Frankel Cardiovascular Center University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott L.","family":"Hummel","sequence":"additional","affiliation":[{"name":"Medical School University of Michigan  Ann Arbor Michigan USA"},{"name":"Frankel Cardiovascular Center University of Michigan  Ann Arbor Michigan USA"},{"name":"Cardiology, VA Ann Arbor Health System  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd M.","family":"Koelling","sequence":"additional","affiliation":[{"name":"Medical School University of Michigan  Ann Arbor Michigan USA"},{"name":"Frankel Cardiovascular Center University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2910-1879","authenticated-orcid":false,"given":"Michael P.","family":"Dorsch","sequence":"additional","affiliation":[{"name":"College of Pharmacy University of Michigan  Ann Arbor Michigan USA"},{"name":"Frankel Cardiovascular Center University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,7,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.0640"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.05.019"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2019.07.455"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","unstructured":"Murray MD Young J Hoke S Wanzhu T Weiner M Morrow D et al. Pharmacist intervention to improve medication adherence in heart failure. Ann Intern Med. 2007;146(10):714\u2010725.","DOI":"10.7326\/0003-4819-146-10-200705150-00005"},{"issue":"10","key":"e_1_2_9_6_1","first-page":"S10","article-title":"The Pharmacist's role in medication optimization for patients with chronic heart failure","volume":"34","author":"Noschese LA","year":"2017","journal-title":"Fed Pract"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","unstructured":"Cordwin DJ Guidi J Alhashimi L Hummel SL Koelling TM Dorsch MP. Differences in provider approach to initiating and titrating guideline directed medical therapy in heart failure with reduced ejection fraction. 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