{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:45:22Z","timestamp":1782992722759,"version":"3.54.5"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Guideline\u2010directed medical therapy (GDMT) improves outcomes in heart failure irrespective of frailty status. Nevertheless, the magnitude of frailty\u2010associated discontinuation of GDMT remains insufficiently studied. We aimed to quantify 12\u2010month discontinuation rates of GDMT across frailty strata.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">This retrospective cohort study used a nationwide insurer\u2010based database. We identified patients aged \u226565\u2009years who were hospitalized for heart failure between 2014 and 2022 and newly initiated on at least 1 GDMT at discharge, including angiotensin\u2010converting enzyme inhibitors\/angiotensin II receptor blockers\/angiotensin receptor\u2010neprilysin inhibitors, \u03b2\u2010blockers, mineralocorticoid receptor antagonists, or SGLT2is (sodium\u2010glucose cotransporter\u20102 inhibitors). Discontinuation was defined as a gap of 60\u2009days without a prescription following the expected completion of the dispensed supply. The cumulative incidence of GDMT discontinuation within 12 months was estimated according to Hospital Frailty Risk Score, with death treated as a competing risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We analyzed 33\u2009155 patients (mean age: 83.2\u2009years, women: 53.0%). The initiating rates were as follows: angiotensin\u2010converting enzyme inhibitors\/angiotensin II receptor blockers\/angiotensin receptor\u2010neprilysin inhibitors 48.3% (N=16\u2009025), \u03b2\u2010blockers 54.9% (N=18\u2009197), mineralocorticoid receptor antagonists 44.1% (N=14\u2009608), and SGLT2is 5.9% (N=1948). The Hospital Frailty Risk Score categories were as follows: low (33.2%), intermediate (47.1%), and severe (19.7%). Discontinuation rates increased with frailty severity: angiotensin\u2010converting enzyme inhibitors\/angiotensin II receptor blockers\/angiotensin receptor\u2010neprilysin inhibitors 27.5%, 39.0%, 45.5% (for low, moderate, and high Hospital Frailty Risk Score, respectively,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001); \u03b2\u2010blockers 22.0%, 28.4%, 33.6%, respectively (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001); and SGLT2is, 32.3%, 34.7%, 40.2%, respectively, (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.008), but not for mineralocorticoid receptor antagonists 42.2%, 42.5%, and 42.3%, respectively, (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.22).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In older adults with heart failure, approximately one\u2010third discontinued GDMT within 12 months, and discontinuation appeared disproportionately common among those with frailty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047638","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T11:35:13Z","timestamp":1773401713000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Discontinuation of Heart Failure Pharmacotherapy in Older Adults With Frailty"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0129-7219","authenticated-orcid":false,"given":"Ryo","family":"Nakamaru","sequence":"first","affiliation":[{"name":"Kyorin University School of Medicine","place":["Tokyo, Japan"]},{"name":"The University of Tokyo Graduate School of 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Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayo M.","family":"Walsh","sequence":"additional","affiliation":[{"name":"The University of Tokyo Graduate School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3779-2972","authenticated-orcid":false,"given":"Shun","family":"Kohsaka","sequence":"additional","affiliation":[{"name":"Yokohama City University","place":["Yokohama, Japan"]},{"name":"Keio University School of Medicine","place":["Tokyo, 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