{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T03:39:14Z","timestamp":1792381154628,"version":"4.4.0"},"reference-count":25,"publisher":"Tsinghua University Press","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"\n Background<\/jats:title>\n Guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (HFrEF) relies on quadruple therapy, including beta-blockers (BB), angiotensin receptor\u2013neprilysin inhibitors (ARNi), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Elderly patients with HF represent a high-risk population and often face therapeutic inertia but also more adverse events. We aimed to assess the efficacy and safety of an intensive titration program (ITP) for elderly HFrEF patients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a prospective, single-center, observational study including HFrEF patients aged \u2265 75 years managed with an ITP between January 2024 and February 2025. The primary outcome was the prescription rate of quadruple GDMT at 3 months, irrespective of dose. Secondary outcomes included prescription of quadruple therapy at \u2265 50% of GDMT target doses and identification of predictors of limited implementation. Safety outcomes included adverse events occurring during titration and within 3 months after completion.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Sixty-four patients were included (Median age 80 years, 70% male, 28% diabetes, median eGFR 50 mL\/min). The mean titration period was 100 days (14 weeks). At 3 months, 33% of patients were prescribed quadruple therapy, with 5% achieving \u2265 50% of the recommended target dose in each drug class. Target dose achievement improved across all drug classes between baseline and 3 months: ARNi (1% vs. 31%), MRA (1% vs. 14%), and BB (3% vs. 5%) (all P <0.05). These improvements were associated with short-term clinical and biological benefits (NT-proBNP reduction, improved left ventricular ejection fraction). Reported adverse events included symptomatic hypotension (8% with treatment discontinuation) and acute kidney injury (8 % requiring hospitalization). Older age and chronic kidney disease were associated with limited initiation of quadruple therapy.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n An intensive titration program for HFrEF therapy appears feasible and relatively safe in elderly patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.26599\/1671-5411.2026.09.007","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T02:39:10Z","timestamp":1792377550000},"page":"590-601","source":"Crossref","is-referenced-by-count":0,"title":["Intensive titration for elderly patients with heart failure"],"prefix":"10.26599","volume":"23","author":[{"given":"Lison","family":"Benezech","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miloud","family":"Cherbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Toulza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Itier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurine","family":"Blasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Galinier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00f4me","family":"Roncalli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cl\u00e9ment","family":"Delmas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline","family":"Fournier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11138","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"ref2","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.acvd.2014.01.012","article-title":"Two-year outcome of patients after a first hospitalization for heart failure: A national observational study","volume":"107","author":"P Tuppin","year":"2014","unstructured":"P Tuppin. Two-year outcome of patients after a first hospitalization for heart failure: A national observational study. 2014, 107: 158-168.","journal-title":"Arch Cardiovasc Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"42","author":"TA McDonagh","year":"2021","unstructured":"TA McDonagh. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. 2021, 42: 3599-3726.","journal-title":"Eur Heart J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.jacc.2018.04.070","article-title":"Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry","volume":"72","author":"SJ Greene","year":"2018","unstructured":"SJ Greene. 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Efficacy and Safety of Heart Failure Treatment According to Frailty Status: A Systematic Review. 2025, 14: e042367.","journal-title":"J Am Heart Assoc"}],"container-title":["Journal of Geriatric Cardiology"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T02:39:11Z","timestamp":1792377551000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.sciopen.com\/article\/10.26599\/1671-5411.2026.09.007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":25,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"URL":"https:\/\/doi.org\/10.26599\/1671-5411.2026.09.007","relation":{},"ISSN":["1671-5411"],"issn-type":[{"value":"1671-5411","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}