{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T16:02:38Z","timestamp":1793116958700,"version":"4.5.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,7,4]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Guidelines recommend using multiple drugs in patients with heart failure (HF) with reduced ejection fraction, but there is a paucity of real\u2010world data on the simultaneous initiation of the 4 pharmacological pillars at discharge after a decompensation event.<\/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\">A retrospective data mart, including patients diagnosed with HF, was implemented. Consecutively admitted patients with HF with reduced ejection fraction were selected through an automated approach and categorized according to the number\/type of treatments prescribed at discharge. The prevalence of contraindications and cautions for HF with reduced ejection fraction treatments was systematically assessed. Logistic regression models were fitted to assess predictors of the number of treatments (\u22652 versus &lt;2 drugs) prescribed and the risk of rehospitalization.<\/jats:p>\n            <jats:p xml:lang=\"en\">A population of 305 patients with a first episode of HF hospitalization and a diagnosis of HF with reduced ejection fraction (ejection fraction, &lt;40%) was selected. At discharge, 49.2% received 2 current recommended drugs, \u03b2\u2010blockers were prescribed in 93.4%, while a renin\u2010angiotensin system inhibitor or an angiotensin receptor\u2013neprilysin inhibitor was prescribed in 68.2%. A mineralocorticoid receptor antagonist was prescribed in 32.5%, although none of the patients showed contraindications to mineralocorticoid receptor antagonist prescription. A sodium\u2010glucose cotransporter 2 inhibitor could be prescribed in 71.1% of patients. On the basis of current recommendations, 46.2% could receive the 4 foundational drugs at discharge. Renal dysfunction was associated with &lt;2 foundational drugs prescribed. After adjusting for age and renal function, use of \u22652 drugs was associated with lower risk of rehospitalization during the 30\u2009days after discharge.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">A quadruple therapy could be directly implementable at discharge, potentially providing prognostic advantages. Renal dysfunction was the main prevalent condition limiting this approach.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.029071","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T10:21:38Z","timestamp":1688034098000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Eligibility for the 4 Pharmacological Pillars in Heart Failure With Reduced Ejection Fraction at Discharge"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3774-8330","authenticated-orcid":false,"given":"Domenico","family":"D'Amario","sequence":"first","affiliation":[{"name":"Department of Translational Medicine Universit\u00e0 del Piemonte Orientale Novara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4690-725X","authenticated-orcid":false,"given":"Daniele","family":"Rodolico","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2402-9444","authenticated-orcid":false,"given":"Agni","family":"Delvinioti","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. 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