{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:04:28Z","timestamp":1792785868441,"version":"4.5.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["25ek0210211h0001"],"award-info":[{"award-number":["25ek0210211h0001"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["25tm0424236h0001"],"award-info":[{"award-number":["25tm0424236h0001"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007449","name":"Takeda Science Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007449","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Mochida Memorial Foundation"},{"DOI":"10.13039\/501100006567","name":"Suhara Memorial Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006567","id-type":"DOI","asserted-by":"publisher"}]},{"name":"SENSIN Medical Research Foundation","id":[{"id":"https:\/\/ror.org\/00krdxg91","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100015639","name":"Japan Cardiovascular Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015639","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008593","name":"Japan Foundation for Aging and Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008732","name":"Uehara Memorial Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008732","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"JSPS","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Optimization of guideline-directed medical therapy (GDMT) is a cornerstone of management in heart failure (HF). The GDMT scoring system was developed to quantify both the use and intensification of GDMT. This study investigated the longitudinal changes in the GDMT score and its association with clinical outcomes in contemporary practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This multicentre prospective cohort study included 680 patients with chronic HF with reduced ejection fraction. The patients were classified into the uptitration (n = 282) and no uptitration (n = 398) groups according to changes in the GDMT score over 9 months. The GDMT score incorporated the use and dose of guideline-recommended drugs including quadruple therapy, ivabradine, and vericiguat. The primary outcome was a composite of all-cause death and hospitalization for worsening HF. Inverse probability of treatment weighting was used to adjust for baseline differences. Uptitration rates at 9 months were 31.8% for renin\u2013angiotensin system blockers, 28.2% for \u03b2-blockers, 10.6% for mineralocorticoid receptor antagonists, and 11.9% for sodium\u2013glucose cotransporter 2 inhibitors. Uptitration was independently associated with baseline GDMT score, age, left ventricular ejection fraction, blood pressure, and renal function. Furthermore, uptitration was associated with a lower incidence of the primary outcome than no uptitration (adjusted HR, 0.65; 95% CI, 0.43\u20130.98).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this contemporary chronic HF cohort, the GDMT score incorporating guideline-recommended drugs revealed suboptimal implementation and intensification of GDMT over 9 months. Greater increases in GDMT score were associated with improved clinical outcomes, supporting the clinical relevance of longitudinal GDMT optimization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcag105","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:46:27Z","timestamp":1781783187000},"page":"1084-1095","source":"Crossref","is-referenced-by-count":3,"title":["Temporal changes in guideline-directed medical therapy score and clinical outcomes in patients with heart failure"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5990-361X","authenticated-orcid":false,"given":"Toshifumi","family":"Tamura","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University , Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638 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Medicine and Graduate School of Medicine, Hokkaido University , Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6254-2225","authenticated-orcid":false,"given":"Isao","family":"Yokota","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Graduate School of Medicine, Hokkaido University , Sapporo 060-8638 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiya","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University , Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638 ,","place":["Japan"]},{"name":"Department of Cardiology, Kushiro City General Hospital , Kushiro 085-0822 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