{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T21:03:01Z","timestamp":1781816581217,"version":"3.54.5"},"reference-count":38,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T00:00:00Z","timestamp":1687392000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K08AG055670"],"award-info":[{"award-number":["K08AG055670"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K24AG073527"],"award-info":[{"award-number":["K24AG073527"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG062713"],"award-info":[{"award-number":["R01AG062713"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Frail older adults may be less likely to receive guideline\u2010directed medical therapy (GDMT)\u2014renin\u2010angiotensin blockers, beta\u2010blockers, and mineralocorticoid receptor antagonists\u2014for heart failure with reduced ejection fraction (HFrEF). We aimed to examine the uptake of angiotensin receptor neprilysin inhibitor (ARNI) and GDMT in frail older adults with HFrEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using 2015\u20132019 Medicare data, we estimated the proportion of beneficiaries with HFrEF receiving ARNI and GDMT each year by frailty status, defined by a claims\u2010based frailty index. Logistic regression was used to identify clinical characteristics associated with ARNI initiation. Cox proportional hazards regression was used to examine the association of GDMT use in 2015 and death or heart failure hospitalization in 2016\u20132019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 147,506\u2013180,386 beneficiaries with HFrEF (mean age: 77\u2009years; 27% women; 42.6\u201349.1% frail) in 2015\u20132019, the proportion of patients receiving ARNI increased in both non\u2010frail (0.4%\u201316.4%) and frail (0.3%\u201313.7%) patients (\n                      <jats:italic>p<\/jats:italic>\n                      for yearly\u2010trend\u2010by\u2010frailty\u2009=\u20090.970). Among those not receiving a renin\u2010angiotensin system blocker, patients with age\u2009\u2265\u200985\u2009years (odds ratio [95% CI], 0.89 [0.80\u20130.99]), dementia (0.88 [0.81\u20130.96]), and frailty (0.87 [0.81\u20130.94]) were less likely to initiate ARNI. The proportion of patients receiving all 3 GDMT classes increased in non\u2010frail patients (22.0%\u201327.0%) but changed minimally in frail patients (19.6%\u201321.8%). Regardless of frailty status, treatment with at least 1 class of GDMT was associated with lower death or heart failure hospitalization than no GDMT medications (hazard ratio [95% CI], 0.94 [0.91\u20130.97], 0.92 [0.89\u20130.94], 0.94 [0.91\u20130.97] for 1, 2, and 3 classes, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results suggest an evidence\u2010practice gap in the use of ARNI and GDMT in Medicare beneficiaries with HFrEF, particularly those with frailty. Efforts to narrow this gap are needed to reduce the burden of HFrEF in older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.18481","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T14:38:44Z","timestamp":1687617524000},"page":"3110-3121","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Frailty and uptake of angiotensin receptor neprilysin inhibitor for heart failure with reduced ejection fraction"],"prefix":"10.1111","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1821-9567","authenticated-orcid":false,"given":"Yu\u2010Chien","family":"Lee","sequence":"first","affiliation":[{"name":"Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife  Boston Massachusetts USA"},{"name":"Department of Family Medicine Chang Gung Memorial Hospital  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua K.","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darae","family":"Ko","sequence":"additional","affiliation":[{"name":"Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife  Boston Massachusetts USA"},{"name":"Section of Cardiovascular Medicine Boston University School of Medicine  Boston Massachusetts 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Medicine Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7290-6838","authenticated-orcid":false,"given":"Dae Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife  Boston Massachusetts USA"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts 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