{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T23:12:54Z","timestamp":1791673974374,"version":"4.3.4"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The purpose of this study was to assess the clinical benefits of guideline\u2010directed medical therapy (GDMT) for heart failure (HF) in adults with congenital heart disease and HF with reduced ejection fraction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">HF with reduced ejection fraction was defined as stage B\/C HF and systemic left ventricular ejection fraction &lt;50%. GDMT score was assessed at baseline encounter (baseline GDMT score) and 1\u2010year follow\u2010up. GDMT uptitration was calculated as defined as \u2206GDMT score from baseline. Cox regression was used to assess the relationship between HF therapy (baseline and \u2206GDMT score) and outcomes (HF hospitalization and mortality).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Of 778 patients (age 44\u00b116, 480 [62%] males), baseline GDMT score was 2 (1, 3) and \u2206GDMT score was 0.62 (95% CI, 0.55\u20130.69). Of 778, only 258 (33%) had GDMT uptitration (\u2206GDMT score &gt;0). Higher use of GDMT at baseline (adjusted HR per 1 point increase in GDMT score 0.81, 95% CI, 0.74\u20130.88,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001), and increased use of GDMT over time (adjusted HR for 1 point increase in \u2206GDMT score HR 0.70, 95% CI, 0.61\u20130.79,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) were associated with lower risk of HF hospitalization. Higher baseline GDMT score (adjusted HR 0.85, 95% CI, 0.76\u20130.94,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001), and \u2206 GDMT score (adjusted HR 0.82, 95% CI, 0.71\u20130.94,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.000) were also associated with lower mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">GDMT use at baseline and GDMT uptitration were associated with improved outcomes and suggest a dose\u2010dependent relationship between use of GDMT and risk of adverse outcomes. Furthermore, 67% of patients did not receive GDMT uptitration, suggesting suboptimal therapy, and opportunities for improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.048260","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T10:50:25Z","timestamp":1779706225000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Benefits of Medical Therapy in Adults With Congenital Heart Disease and Systemic Left Ventricular Presenting With Heart Failure With Reduced Ejection Fraction"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2854-8275","authenticated-orcid":false,"given":"Mohamed","family":"Ellabbad","sequence":"first","affiliation":[{"name":"Mayo Clinic","place":["Rochester, 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USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8810-3631","authenticated-orcid":false,"given":"Alexander C.","family":"Egbe","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, 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