{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:07:59Z","timestamp":1790816879171,"version":"4.1.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,8,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Cardiology has advanced guideline development and quality measurement. Recognizing the substantial benefits of guideline\u2010directed medical therapy, this study aims to measure and explain apparent deviations in heart failure (\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              ) guideline adherence by clinicians at hospital discharge and describe any impact on readmission rates.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The extent of decongestion and prescription of neurohormonal therapy were recorded prospectively for 226\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              discharges, including 132 (58%) from an academic hospital and 94 (42%) from a community hospital. Among all discharges, 25% were discharged with residual congestion (30% academic versus 18% community,\n              <jats:italic>P<\/jats:italic>\n              =0.070). Among discharges of patients with HF with reduced ejection fraction, 37% (45% academic versus 18% community,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) were discharged without \u03b2\u2010blocker therapy or with lower doses than at admission. Moreover, 46% of patients with HF with reduced ejection fraction (48% academic versus 39% community,\n              <jats:italic>P<\/jats:italic>\n              =0.390) were discharged without an angiotensin\u2010converting enzyme inhibitor or angiotensin\n              <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>\n              receptor blocker or with lower doses than at admission. Renal dysfunction was the most common reason for discharge with congestion, and hypotension the most common reason for discharge with no or decreased neurohormonal therapy. There was a trend toward higher 90\u2010day readmission rates after discharge with residual congestion.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Clinicians frequently deviate from guidelines in both academic and community hospitals; however, this deviation may not always indicate poor quality. Application of guidelines recommended for stable populations is increasingly limited for hospitalized patients by hypotension, renal dysfunction, and inotrope use. Patients with renal dysfunction, hypotension, and recent inotrope use merit further study to determine best practices and possibly to adjust quality metrics for\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              severity.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.008789","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T06:43:15Z","timestamp":1537080195000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Reasons for Guideline Nonadherence at Heart Failure Discharge"],"prefix":"10.1161","volume":"7","author":[{"given":"Lauren G.","family":"Gilstrap","sequence":"first","affiliation":[{"name":"Cardiovascular Medicine Division Brigham and Women's Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne 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MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Carr","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Division Brigham and Women's Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roya","family":"Ghazinouri","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Division Brigham and Women's Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Rathman","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Division Lancaster General Hospital Lancaster PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Han","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Division Brigham and Women's Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep 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