{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T03:49:23Z","timestamp":1776743363789,"version":"3.51.2"},"reference-count":15,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,8,29]],"date-time":"2018-08-29T00:00:00Z","timestamp":1535500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Guideline\u2010directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) has been challenging to achieve universally. Healthcare providers who seek to achieve optimal medical therapy frequently consider either a wearable cardioverter defibrillator (WCD) or an implantable cardioverter defibrillator (ICD) as indicated. The dynamic process of communication and physician recommendations marks a setting to study the relative interdependence of medical therapies and best practice. The purpose of this study was to examine the long\u2010term impact of the WCD on GDMT. We hypothesized the WCD serves as a \u201cgateway\u201d therapy, likely impacting other optimal strategies such that successful use of WCD improves GDMT adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Electronic medical records (EPIC) were manually reviewed to extract data elements in this observational study of 1289 HFrEF patients from 2013\u20102015. Data included demographics, comorbidities, and use of GDMT including an ICD use in persistently low ejection fraction (\u226436%) patients after 90 days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>WCD use was significantly associated with prescribing adherence to GDMT, <jats:italic>\u03c7<jats:sup>2<\/jats:sup><\/jats:italic> (1, <jats:italic>N<\/jats:italic>\u00a0=\u00a0981)\u00a0=\u00a033.36, <jats:italic>P\u00a0<\/jats:italic>&lt;\u00a00.001. Further, WCD use was significantly associated with recommendations for follow\u2010up echocardiographic study, <jats:italic>\u03c7<jats:sup>2<\/jats:sup><\/jats:italic> (1, <jats:italic>N<\/jats:italic>\u00a0=\u00a0865)\u00a0=\u00a066.94, <jats:italic>P\u00a0<\/jats:italic>&lt;\u00a00.001 and use of primary prevention ICD, <jats:italic>\u03c7<jats:sup>2<\/jats:sup><\/jats:italic> (1, <jats:italic>N<\/jats:italic>\u00a0=\u00a01093)\u00a0=\u00a019.00, <jats:italic>P\u00a0<\/jats:italic>&lt;\u00a00.001.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study demonstrates the use of the WCD correlates with improved clinician use of GDMT, follow\u2010up echocardiographic studies, and appropriate use of primary prevention ICD. Thus, the potential benefits of the WCD and its care processes may extend beyond prevention of sudden cardiac death to enhanced optimization of GDMT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.13472","type":"journal-article","created":{"date-parts":[[2018,8,9]],"date-time":"2018-08-09T13:39:52Z","timestamp":1533821992000},"page":"1314-1320","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Playing it close to the VEST and the clinical guidelines: Clinical guideline compliance in HFrEF patients\u2014Role of WCD"],"prefix":"10.1111","volume":"41","author":[{"given":"Michael J.","family":"Mirro","sequence":"first","affiliation":[{"name":"Parkview Research Center Parkview Health System  Fort Wayne Indiana"},{"name":"Indiana University School of Medicine  Indianapolis Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily E.","family":"Keltner","sequence":"additional","affiliation":[{"name":"Parkview Research Center Parkview Health System  Fort Wayne Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5240-0458","authenticated-orcid":false,"given":"Amelia E.","family":"Roebuck","sequence":"additional","affiliation":[{"name":"Parkview Research Center Parkview Health System  Fort Wayne Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7863-3591","authenticated-orcid":false,"given":"Samuel F.","family":"Sears","sequence":"additional","affiliation":[{"name":"Department of Psychology and Cardiovascular Sciences East Carolina University  Greenville North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,8,29]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"e1","article-title":"Heart disease and stroke statistics\u20142016 update: A Report from the American Heart Association","volume":"133","author":"Mozaffarian D","year":"2016","journal-title":"Circulation"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.08.042"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.934471"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.09.045"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.773838"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)02670-0"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.108.772228"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.03.043"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.112.973552"},{"key":"e_1_2_9_11_1","unstructured":"OlginJ PletcherM VIttinghoffE et\u00a0al.VEST Prevention of Early Sudden Death Trial: Efficacy of a wearable cardioverter\u2010defibrillator after myocardial infarction. Presented as Late Breaking Clinical Trial at the 2018 American College of Cardiology Annual Scientific Sessions March 10 2018 New Orleans LA."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.1061"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.0037"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558715573871"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000394"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181bc7bd5"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpace.13472","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.13472","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T04:35:40Z","timestamp":1694925340000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.13472"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,29]]},"references-count":15,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1111\/pace.13472"],"URL":"https:\/\/doi.org\/10.1111\/pace.13472","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,29]]},"assertion":[{"value":"2017-12-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}