{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:23:02Z","timestamp":1793398982667,"version":"4.5.0"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2024,2,13]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Guideline-directed medical therapies (GDMTs) are the mainstay of treatment for heart failure with reduced ejection fraction (HFrEF), but they are underused. Whether sex differences exist in the initiation and intensification of GDMT for newly diagnosed HFrEF is not well established.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>Patients with incident HFrEF were identified from the 2016 to 2020 Optum deidentified Clinformatics Data Mart Database, which is derived from a database of administrative health claims for members of large commercial and Medicare Advantage health plans. The primary outcome was the use of optimal GDMT within 12 months of HFrEF diagnosis. Consistent with the guideline recommendations during the time period of the study, optimal GDMT was defined as \u226550% of the target dose of evidence-based beta-blocker plus \u226550% of the target dose of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, or any dose of angiotensin receptor neprilysin inhibitor plus any dose of mineralocorticoid receptor antagonist. The probability of achieving optimal GDMT on follow-up and predictors of optimal GDMT were evaluated with time-to-event analysis with adjusted Cox proportional hazard models.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              The study cohort included 63\u2009759 patients (mean age, 71.3 years; 15.2% non-Hispanic Black race; 56.6% male). Optimal GDMT use was achieved by 6.2% of patients at 12 months after diagnosis. Female (compared with male) patients with HFrEF had lower use across every GDMT class and lower use of optimal GDMT at each time point at follow-up. In an adjusted Cox model, female sex was associated with a 23% lower probability of achieving optimal GDMT after diagnosis (hazard ratio [HR], 0.77 [95% CI, 0.71\u20130.83];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). The sex disparities in GDMT use after HFrEF diagnosis were most pronounced among patients with commercial insurance (females compared with males; HR, 0.66 [95% CI, 0.58\u20130.76]) compared with Medicare (HR, 0.85 [95% CI, 0.77\u20130.92]);\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              <jats:sub>interaction<\/jats:sub>\n              sex\u00d7insurance status=0.005) and for younger patients (age &lt;65 years: HR, 0.65 [95% CI, 0.58\u20130.74]) compared with older patients (age \u226565 years: HR, 87 [95% CI, 80\u201396])\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              <jats:sub>interaction<\/jats:sub>\n              sex\u00d7age=0.009).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Overall use of optimal GDMT after HFrEF diagnosis was low, with significantly lower use among female (compared with male) patients. These findings highlight the need for implementation efforts directed at improving GDMT initiation and titration.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.123.067489","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T10:00:42Z","timestamp":1706004042000},"page":"510-520","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":74,"title":["Sex Disparities in Longitudinal Use and Intensification of Guideline-Directed Medical Therapy Among Patients With Newly Diagnosed Heart Failure With Reduced Ejection Fraction"],"prefix":"10.1161","volume":"149","author":[{"given":"Andrew","family":"Sumarsono","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX (A.S., N.K., L.B.P., J.T.T., 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S.E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lajjaben","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8711-6756","authenticated-orcid":true,"given":"Windy W.","family":"Alonso","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Nebraska Medical Center, Omaha (W.W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9131-685X","authenticated-orcid":true,"given":"Jennifer T.","family":"Thibodeau","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX (A.S., N.K., L.B.P., J.T.T., A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3192-8093","authenticated-orcid":true,"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8370-4569","authenticated-orcid":true,"given":"Harriette G.C.","family":"Van Spall","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton, Ontario, Canada (H.G.C.V.S.)."},{"name":"McMaster University, Hamilton, Ontario, Canada (H.G.C.V.S.)."},{"name":"Research Institute of St. Joseph\u2019s, Hamilton, Ontario, Canada (H.G.C.V.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6685-2175","authenticated-orcid":true,"given":"Sarah E.","family":"Messiah","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Texas Health Science Center at Houston (L.X., C.Z., 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A Keshvani N Sumarsono A Desai R Khan MS Menon V Hsich E Bress AP Jacobs J Vasan RS et al. Patterns prognostic implications and rural-urban disparities in optimal GDMT following HFrEF diagnosis among Medicare beneficiaries [published online October 26 2023]. 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