{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:23:38Z","timestamp":1783463018614,"version":"3.55.0"},"reference-count":21,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Region of Kronoberg, Sweden","award":["doctoral project funding awarded to KSS"],"award-info":[{"award-number":["doctoral project funding awarded to KSS"]}]},{"name":"Astra Zeneca","award":["to Kristina Sundquist"],"award-info":[{"award-number":["to Kristina Sundquist"]}]},{"name":"Primary Care Sk\u00e5ne","award":["to Kristina Sundquist"],"award-info":[{"award-number":["to Kristina Sundquist"]}]},{"name":"The Swedish Society of Medicine and Swedish governmental funding of clinical research","award":["awarded to Veronica Milos Nymberg"],"award-info":[{"award-number":["awarded to Veronica Milos Nymberg"]}]},{"DOI":"10.13039\/100004336","name":"Novartis","doi-asserted-by":"publisher","award":["to Kristina Sundquist"],"award-info":[{"award-number":["to Kristina Sundquist"]}],"id":[{"id":"10.13039\/100004336","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001003","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","award":["to Kristina Sundquist"],"award-info":[{"award-number":["to Kristina Sundquist"]}],"id":[{"id":"10.13039\/100001003","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"crossref","award":["2023-05742"],"award-info":[{"award-number":["2023-05742"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,16]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to describe clinical and diagnostic characteristics of primary care patients with heart failure and physicians\u2019 adherence to guideline-directed medical therapy (GDMT) for treating chronic heart failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study based on baseline data from the prospective primary care-based study Heart failure in Southern Sweden (HISS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Patients with heart failure were included from 20 primary healthcare centres in the southernmost region of Sweden (Sk\u00e5ne).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Between 2020 and 2023, patients were included in HISS, resulting in a total of 587 participants. Of these, 558 patients (95% of the HISS participants) had available data on left ventricular ejection fraction and were included in this study. Adult patients aged 18 years or older diagnosed with heart failure (International Classification of Diseases, 10th Revision codes I50, I11.0, I42, I43) were considered eligible for inclusion in HISS. Community-dwelling patients with assisted care were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcomes<\/jats:title>\n                    <jats:p>The primary outcome measures were distribution of heart failure subtypes and prescribed medications. The secondary outcomes were temporal trends in GDMT and the association between physicians\u2019 adherence to GDMT and clinical characteristics of patients, using logistic regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Heart failure with preserved ejection fraction (HFpEF) was the most prevalent subtype (42%), followed by mildly reduced (30%) and reduced ejection fraction (HFrEF, 28%). Among patients with HFrEF, 20% were prescribed the recommended GDMT according to the European Society of Cardiology (ESC) 2021 guidelines, which consisted of a renin-angiotensin system inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and a sodium-glucose 2 inhibitor. We observed no significant change in the prescribing trends for the quadruple therapy in patients with HFrEF when comparing the 2 years before and after the publication of the ESC 2021 guidelines. Similarly, we observed no association between patient characteristics and the prescription of GDMT according to ESC 2021 for patients with HFrEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HFpEF was the most prevalent subtype, with conclusive and recent echocardiography data among two-thirds of the cohort. Temporal trends in prescription patterns showed no appreciable increase in the use of GDMT for HFrEF during the two years following guideline publication compared with the two preceding years. These findings indicate a need for inclusion of primary care patients as a basis for intensified medical recommendations and implementation strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04129658\">NCT04129658<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-101178","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T13:46:04Z","timestamp":1762263964000},"page":"e101178","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Heart failure in Southern Sweden (HISS): a cross-sectional analysis of primary care patients\u2019 characteristics and physicians\u2019 adherence to guideline-directed medical therapy"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct04129658","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04129658","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5326-6618","authenticated-orcid":false,"given":"Karin","family":"Svensson S\u00f6derberg","sequence":"first","affiliation":[{"name":"Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malm\u00f6, Sweden"},{"name":"Regional Department of Competence in Family Medicine and Primary Health Care, Region Kronoberg, V\u00e4xj\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lo","family":"Kronestedt Lundevall","sequence":"additional","affiliation":[{"name":"Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Lindow","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University Faculty of Medicine, Lund, Sweden"},{"name":"Research and Development, Region Kronoberg, V\u00e4xj\u00f6, Sweden"},{"name":"Department of Medicine, V\u00e4xj\u00f6 Central Hospital, Region Kronoberg, V\u00e4xj\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3263-2718","authenticated-orcid":false,"given":"Oscar","family":"\u00d6 Braun","sequence":"additional","affiliation":[{"name":"Cardiology, Department of Clinical Sciences, Lund University and Sk\u00e5ne University Hospital, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6285-9935","authenticated-orcid":false,"given":"J Gustav","family":"Smith","sequence":"additional","affiliation":[{"name":"Cardiology, Department of Clinical Sciences, Lund University and Sk\u00e5ne University Hospital, Lund, Sweden"},{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden"},{"name":"Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Sundquist","sequence":"additional","affiliation":[{"name":"Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malm\u00f6, Sweden"},{"name":"University Clinic Primary Care, Sk\u00e5ne University Hospital, Region Sk\u00e5ne, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3836-3048","authenticated-orcid":false,"given":"Veronica","family":"Milos Nymberg","sequence":"additional","affiliation":[{"name":"Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malm\u00f6, Sweden"},{"name":"University Clinic Primary Care, Sk\u00e5ne University Hospital, Region Sk\u00e5ne, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"2025120413252658000_15.11.e101178.1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-064997","article-title":"Clinical characteristics and mortality of patients with heart failure in Southern Sweden from 2013 to 2019: a population-based cohort study","volume":"12","author":"Davidge","year":"2022","journal-title":"BMJ Open"},{"key":"2025120413252658000_15.11.e101178.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.03.006"},{"key":"2025120413252658000_15.11.e101178.3","unstructured":"Nationella riktlinjer for hj\u00e4rtsjukv\u00e5rd st\u00f6d f\u00f6r styrning och ledning. 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