{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:56:02Z","timestamp":1793382962690,"version":"4.5.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,6,20]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>BACKGROUND<\/jats:title>\n            <jats:p xml:lang=\"en\">Guideline\u2010recommended therapies that improve prognosis remain underused in clinical practice. Physical frailty may lead to underprescription of life\u2010saving therapy. We aimed to investigate the association between physical frailty and the use of evidence\u2010based pharmacological therapy for heart failure with reduced ejection fraction and the impact of this on prognosis.<\/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 FLAGSHIP (Multicentre Prospective Cohort Study to Develop Frailty\u2010Based Prognostic Criteria for Heart Failure Patients) included patients hospitalized for acute heart failure, and data on physical frailty were collected prospectively. We analyzed 1041 patients with heart failure with reduced ejection fraction (aged 70\u2009years; 73% male) and divided them by physical frailty categories using grip strength, walking speed, Self\u2010Efficacy for Walking\u20137 score, and Performance Measures for Activities of Daily Living\u20138 score: categories I (n=371; least frail), II (n=275), III (n=224), and IV (n=171). Overall prescription rates of angiotensin\u2010converting enzyme inhibitors\/angiotensin receptor blockers, \u03b2\u2010blockers, and mineralocorticoid receptor antagonists were 69.7%, 87.8%, and 51.9%, respectively. The proportion of patients receiving all 3 drugs decreased as physical frailty increased (in category I patients, 40.2%; IV patients, 23.4%;\n              <jats:italic>P<\/jats:italic>\n              for trend&lt;0.001). In adjusted analyses, the severity of physical frailty was an independent predictor for nonuse of angiotensin\u2010converting enzyme inhibitors\/angiotensin receptor blockers (odds ratio [OR], 1.23 [95% CI, 1.05\u20131.43] per 1 category increase) and \u03b2\u2010blockers (OR, 1.32 [95% CI, 1.06\u20131.64]), but not mineralocorticoid receptor antagonists (OR, 0.97 [95% CI, 0.84\u20131.12]). Patients receiving 0 to 1 drug had a higher risk of the composite outcome of all\u2010cause death or heart failure rehospitalization than those treated with 3 drugs in physical frailty categories I and II (hazard ratio [HR], 1.80 [95% CI, 1.08\u20132.98]) and III and IV (HR, 1.53 [95% CI, 1.01\u20132.32]) in the multivariate Cox proportional hazard model.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>CONCLUSIONS<\/jats:title>\n            <jats:p xml:lang=\"en\">Prescription of guideline\u2010recommended therapy decreased as severity of physical frailty increased in heart failure with reduced ejection fraction. Underprescription of guideline\u2010recommended therapy may contribute to the poor prognosis associated with physical frailty.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.026844","type":"journal-article","created":{"date-parts":[[2023,6,11]],"date-time":"2023-06-11T02:20:51Z","timestamp":1686450051000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Physical Frailty and Use of Guideline\u2010Recommended Drugs in Patients With Heart Failure and Reduced Ejection Fraction"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6853-7574","authenticated-orcid":false,"given":"Toru","family":"Kondo","sequence":"first","affiliation":[{"name":"Department of Cardiology Nagoya University Graduate School of Medicine Nagoya Japan"},{"name":"British Heart Foundation Cardiovascular Research Centre University of Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9756-0343","authenticated-orcid":false,"given":"Takuji","family":"Adachi","sequence":"additional","affiliation":[{"name":"Department of Integrated Health Sciences Nagoya University Graduate School of Medicine Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyonori","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Nagoya University Hospital Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5076-2052","authenticated-orcid":false,"given":"Takahiro","family":"Okumura","sequence":"additional","affiliation":[{"name":"Department of Cardiology Nagoya University Graduate School of Medicine Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2136-2855","authenticated-orcid":false,"given":"Hideo","family":"Izawa","sequence":"additional","affiliation":[{"name":"Department of Cardiology Fujita Health University Toyoake Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2723-6243","authenticated-orcid":false,"given":"Toyoaki","family":"Murohara","sequence":"additional","affiliation":[{"name":"Department of Cardiology Nagoya University Graduate School of Medicine Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6317-3975","authenticated-orcid":false,"given":"John J. V.","family":"McMurray","sequence":"additional","affiliation":[{"name":"British Heart Foundation Cardiovascular Research Centre University of Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumio","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Integrated Health Sciences Nagoya University Graduate School of Medicine Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000659"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.72.489"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000509"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-19-0342"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.04.070"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.10.010"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2020.04.019"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.887"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx026"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30306-1"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/56.3.M146"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1611"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.07.032"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12803"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.01.153"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2019.10.005"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.518"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s41999-021-00471-x"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2017.04.001"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.161.22.2721"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-018-0897-y"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1159\/000248628"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.09.055"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs337"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.109.854877"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12603-018-1054-0"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.109.879478"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1832"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1308"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.061339"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afx127"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.8844"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.10565"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.122.026844","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T12:45:00Z","timestamp":1715604300000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.122.026844"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,20]]},"references-count":34,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2023,6,20]]}},"alternative-id":["10.1161\/JAHA.122.026844"],"URL":"https:\/\/doi.org\/10.1161\/jaha.122.026844","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,20]]},"assertion":[{"value":"2022-06-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e026844"}}