{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:02:18Z","timestamp":1790791338737,"version":"4.1.0"},"reference-count":40,"publisher":"IMR Press","issue":"9","license":[{"start":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T00:00:00Z","timestamp":1694995200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Major Projects of Sichuan Provincial Health Commission","award":["21ZD004"],"award-info":[{"award-number":["21ZD004"]}]},{"name":"Science and Technology Department of Sichuan Province Project","award":["2021YJ0208"],"award-info":[{"award-number":["2021YJ0208"]}]},{"name":"Science and Technology Department of Sichuan Province Project","award":["2021YJ0210"],"award-info":[{"award-number":["2021YJ0210"]}]},{"name":"Research Project Foundation of Affiliated Hospital of North Sichuan Medical College","award":["2022LC009"],"award-info":[{"award-number":["2022LC009"]}]},{"name":"Research Project Foundation of Affiliated Hospital of North Sichuan Medical College","award":["2021ZK002"],"award-info":[{"award-number":["2021ZK002"]}]},{"name":"Research Project Foundation of Affiliated Hospital of North Sichuan Medical College","award":["2021LC011"],"award-info":[{"award-number":["2021LC011"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Background: Although compliance with the guideline recommendations for heart failure (HF) is associated with improved survival, the effects of medication on clinical practice often fail to meet expectations due to physician and\/or patient-related reasons that are unclear. This study analyzed physicians\u2019 compliance with guideline-directed medical therapy (GDMT) based on real-world clinical data and identified risk factors of low compliance. Methods: This study included patients with HF, who were treated at the Affiliated Hospital of North Sichuan Medical College from July 2017 to June 2021. All patients were divided into high compliance, moderate compliance, and low compliance with GDMT groups. The proportion of patients receiving treatment in compliance with GDMT was analyzed, the relationship between compliance with GDMT and clinical outcomes was evaluated, and the risk factors of low compliance were identified. Results: Of all patients with HF included in the study, 498 (23.8%) had low compliance with GDMT, 1413 (67.4%) had moderate compliance with GDMT, and 185 (8.8%) had high compliance with GDMT. The readmission rate of patients in the moderate compliance with GDMT group was significantly higher than that in the high and low compliance groups (p = 0.028). There were no significant differences in the rates of severe cardiovascular disease among the three groups. The mortality rate of patients in the high compliance with GDMT group was significantly higher than that of the other groups (p &lt; 0.001). We found that a history of hypertension; New York Heart Association (NYHA) classification (III and IV vs. I); and abnormal heart rate, high-sensitive troponin T (hsTnT), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), uric acid, and left ventricular diastolic dysfunction (LVDD) were all significantly associated with low compliance with GDMT. Conclusions: The proportion of physicians\u2019 compliance with GDMT in treating patients with HF is low. Risk factors of low compliance include hypertension; NYHA classification (III and IV vs. I); and abnormal heart rate, hsTnT, NT proBNP, uric acid, and LVDD.<\/jats:p>","DOI":"10.31083\/j.rcm2409257","type":"journal-article","created":{"date-parts":[[2023,9,20]],"date-time":"2023-09-20T06:26:53Z","timestamp":1695191213000},"source":"Crossref","is-referenced-by-count":2,"title":["Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Study"],"prefix":"10.31083","volume":"24","author":[{"given":"Guixia","family":"Wang","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital, Jinan University, 510630 Guangzhou, Guangdong, China"},{"name":"Infectious Department, Affiliated Hospital of North Sichuan Medical College, 2262110 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liming","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Gerontology, Affiliated Hospital of North Sichuan Medical College, 2262110 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobo","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, 637002 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Yu","sequence":"first","affiliation":[{"name":"Infectious Department, Affiliated Hospital of North Sichuan Medical College, 2262110 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, 637002 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingjun","family":"Zhang","sequence":"first","affiliation":[{"name":"Infectious Department, Affiliated Hospital of North Sichuan Medical College, 2262110 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiafu","family":"Lin","sequence":"first","affiliation":[{"name":"Infectious Department, Affiliated Hospital of North Sichuan Medical College, 2262110 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, 637002 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanxu","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, 637002 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lanxiang","family":"Jiang","sequence":"first","affiliation":[{"name":"Undergraduate in Clinical Medicine, North Sichuan Medical College, 2262110 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenlong","family":"Hu","sequence":"first","affiliation":[{"name":"Undergraduate in Clinical Medicine, North Sichuan Medical College, 2262110 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houxiang","family":"Hu","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital, Jinan University, 510630 Guangzhou, Guangdong, China"},{"name":"Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, 637002 Nanchong, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2023,9,18]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Maggioni AP, Dahlstr\u00f6m U, Filippatos G, Chioncel O, Leiro MC, Drozdz J, et al. EURObservational Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot). European Journal of Heart Failure. 2010; 12: 1076\u20131084.","DOI":"10.1093\/eurjhf\/hfq154"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Sahle BW, Owen AJ, Mutowo MP, Krum H, Reid CM. Prevalence of heart failure in Australia: a systematic review. BMC Cardiovascular Disorders. 2016; 16: 32.","DOI":"10.1186\/s12872-016-0208-4"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"van der Meer P, Gaggin HK, Dec GW. ACC\/AHA Versus ESC Guidelines on Heart Failure: JACC Guideline Comparison. Journal of the American College of Cardiology. 2019; 73: 2756\u20132768.","DOI":"10.1016\/j.jacc.2019.03.478"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Wang H, Chai K, Du M, Wang S, Cai JP, Li Y, et al. Prevalence and Incidence of Heart Failure Among Urban Patients in China: A National Population-Based Analysis. Circulation: Heart Failure. 2021; 14: e008406.","DOI":"10.1161\/CIRCHEARTFAILURE.121.008406"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, B\u00f6hm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2021; 42: 3599\u20133726.","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145: e895\u2013e1032.","DOI":"10.1161\/CIR.0000000000001073"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Krum H, Abraham WT. Heart failure. Lancet. 2009; 373: 941\u2013955.","DOI":"10.1016\/S0140-6736(09)60236-1"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Liu SS, Monti J, Kargbo HM, Athar MW, Parakh K. Frontiers of therapy for patients with heart failure. The American Journal of Medicine. 2013; 126: 6\u201312.e6.","DOI":"10.1016\/j.amjmed.2012.04.033"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Ahn MS, Yoo BS, Son JW, Park YJ, Lee HY, Jeon ES, et al. Evaluation of Adherence to Guideline for Heart Failure with Reduced Ejection Fraction in Heart Failure with Preserved Ejection Fraction and with or without Atrial Fibrillation. Journal of Korean Medical Science. 2021; 36: e252.","DOI":"10.3346\/jkms.2021.36.e252"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"De Blois J, Fagerland MW, Grundtvig M, Semb AG, Gullestad L, Westheim A, et al. ESC guidelines adherence is associated with improved survival in patients from the Norwegian Heart Failure Registry. European Heart Journal-Cardiovascular Pharmacotherapy. 2015; 1: 31\u201336.","DOI":"10.1093\/ehjcvp\/pvu010"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Jarjour M, Henri C, de Denus S, Fortier A, Bouabdallaoui N, Nigam A, et al. Care Gaps in Adherence to Heart Failure Guidelines: Clinical Inertia or Physiological Limitations? Heart Failure. 2020; 8: 725\u2013738.","DOI":"10.1016\/j.jchf.2020.04.019"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"de Groote P, Isnard R, Assyag P, Clerson P, Ducardonnet A, Galinier M, et al. Is the gap between guidelines and clinical practice in heart failure treatment being filled? Insights from the IMPACT RECO survey. European Journal of Heart Failure. 2007; 9: 1205\u20131211.","DOI":"10.1016\/j.ejheart.2007.09.008"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Fonarow GC, Ziaeian B. Gaps in Adherence to Guideline-Directed Medical Therapy Before Defibrillator Implantation. Journal of the American College of Cardiology. 2016; 67: 1070\u20131073.","DOI":"10.1016\/j.jacc.2015.12.045"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Kocaba\u015f U, K\u0131vrak T, Y\u0131lmaz \u00d6ztekin GM, Tan\u0131k VO, \u00d6zdemir IH, Kaya E, et al. Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: The ATA study. Anatolian Journal of Cardiology. 2020; 24: 32\u201340.","DOI":"10.14744\/AnatolJCardiol.2020.91771"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Fitzgerald AA, Powers JD, Ho PM, Maddox TM, Peterson PN, Allen LA, et al. Impact of medication nonadherence on hospitalizations and mortality in heart failure. Journal of Cardiac Failure. 2011; 17: 664\u2013669.","DOI":"10.1016\/j.cardfail.2011.04.011"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"O\u2019Meara E, Lewis E, Granger C, Dunlap ME, McKelvie RS, Probstfield JL, et al. Patient perception of the effect of treatment with candesartan in heart failure. Results of the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) programme. European Journal of Heart Failure. 2005; 7: 650\u2013656.","DOI":"10.1016\/j.ejheart.2005.01.021"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Kolandaivelu K, Leiden BB, O\u2019Gara PT, Bhatt DL. Non-adherence to cardiovascular medications. European Heart Journal. 2014; 35: 3267\u20133276.","DOI":"10.1093\/eurheartj\/ehu364"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Dronkers EAC, Mes SW, Wieringa MH, van der Schroeff MP, Baatenburg de Jong RJ. Noncompliance to guidelines in head and neck cancer treatment; associated factors for both patient and physician. BMC Cancer. 2015; 15: 515.","DOI":"10.1186\/s12885-015-1523-3"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Reiner Z, Sonicki Z, Tedeschi-Reiner E. Physicians\u2019 perception, knowledge and awareness of cardiovascular risk factors and adherence to prevention guidelines: the PERCRO-DOC survey. Atherosclerosis. 2010; 213: 598\u2013603.","DOI":"10.1016\/j.atherosclerosis.2010.09.014"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Mah\u00e9 I, Chidiac J, Helfer H, Noble S. Factors influencing adherence to clinical guidelines in the management of cancer-associated thrombosis. Journal of Thrombosis and Haemostasis. 2016; 14: 2107\u20132113.","DOI":"10.1111\/jth.13483"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Papadimitriou L, Hamo CE, Butler J. Heart Failure Guidelines on Pharmacotherapy. Handbook of Experimental Pharmacology. 2017; 243: 109\u2013129.","DOI":"10.1007\/164_2017_24"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Teng THK, Tromp J, Tay WT, Anand I, Ouwerkerk W, Chopra V, et al. Prescribing patterns of evidence-based heart failure pharmacotherapy and outcomes in the ASIAN-HF registry: a cohort study. The Lancet Global Health. 2018; 6: e1008\u2013e1018.","DOI":"10.1016\/S2214-109X(18)30306-1"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"McMurray JJV, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. The New England Journal of Medicine. 2014; 371: 993\u20131004.","DOI":"10.1056\/NEJMoa1409077"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"McMurray JJV, Krum H, Abraham WT, Dickstein K, K\u00f8ber LV, Desai AS, et al. Aliskiren, Enalapril, or Aliskiren and Enalapril in Heart Failure. The New England Journal of Medicine. 2016; 374: 1521\u20131532.","DOI":"10.1056\/NEJMoa1514859"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Al-Aghbari S, Al-Maqbali JS, Alawi AMA, Za\u2019abi MA, Al-Zakwani I. Guideline-directed medical therapy in heart failure patients with reduced ejection fraction in Oman: utilization, reasons behind non-prescribing, and dose optimization. Pharmacy Practice. 2022; 20: 2642.","DOI":"10.18549\/PharmPract.2022.2.2642"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, et al. Medical Therapy for Heart Failure with Reduced Ejection Fraction: The CHAMP-HF Registry. Journal of the American College of Cardiology. 2018; 72: 351\u2013366.","DOI":"10.1016\/j.jacc.2018.04.070"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Komajda M, Anker SD, Cowie MR, Filippatos GS, Mengelle B, Ponikowski P, et al. Physicians\u2019 adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey. European Journal of Heart Failure. 2016; 18: 514\u2013522.","DOI":"10.1002\/ejhf.510"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Komajda M, Sch\u00f6pe J, Wagenpfeil S, Tavazzi L, B\u00f6hm M, Ponikowski P, et al. Physicians\u2019 guideline adherence is associated with long-term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry. European Journal of Heart Failure. 2019; 21: 921\u2013929.","DOI":"10.1002\/ejhf.1459"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Komajda M, Cowie MR, Tavazzi L, Ponikowski P, Anker SD, Filippatos GS, et al. Physicians\u2019 guideline adherence is associated with better prognosis in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry. European Journal of Heart Failure. 2017; 19: 1414\u20131423.","DOI":"10.1002\/ejhf.887"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Liu J, Masoudi FA, Spertus JA, Wang Q, Murugiah K, Spatz ES, et al. Patterns of use of angiotensin-converting enzyme inhibitors\/angiotensin receptor blockers among patients with acute myocardial infarction in China from 2001 to 2011: China PEACE-Retrospective AMI Study. Journal of the American Heart Association. 2015; 4: e001343.","DOI":"10.1161\/JAHA.114.001343"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Guan W, Murugiah K, Downing N, Li J, Wang Q, Ross JS, et al. National quality assessment evaluating spironolactone use during hospitalization for acute myocardial infarction (AMI) in China: China Patient-centered Evaluation Assessment of Cardiac Events (PEACE)-Retrospective AMI Study, 2001, 2006, and 2011. Journal of the American Heart Association. 2015; 4: e001718.","DOI":"10.1161\/JAHA.114.001718"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Ng LP, Goh PSC. Incidence of discontinuation of angiotensin-converting enzyme inhibitors due to cough, in a primary healthcare centre in Singapore. Singapore Medical Journal. 2014; 55: 146\u2013149.","DOI":"10.11622\/smedj.2014034"},{"key":"ref33","unstructured":"Heart Failure Group of Chinese Society of Cardiology of Chinese Medical Association, Chinese Heart Failure Association of Chinese Medical Doctor Association, Editorial Board of Chinese Journal of Cardiology. Chinese guidelines for the diagnosis and treatment of heart failure 2018. Zhonghua Xin Xue Guan Bing Za Zhi. 2018; 46: 760\u2013789."},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Liao JK. Safety and efficacy of statins in Asians. The American Journal of Cardiology. 2007; 99: 410\u2013414.","DOI":"10.1016\/j.amjcard.2006.08.051"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Okamoto H, Hori M, Matsuzaki M, Tsutsui H, Yamazaki T, Nagai R, et al. Minimal dose for effective clinical outcome and predictive factors for responsiveness to carvedilol: Japanese chronic heart failure (J-CHF) study. International Journal of Cardiology. 2013; 164: 238\u2013244.","DOI":"10.1016\/j.ijcard.2012.11.051"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Lee YJ, Tsai JC. Angiotensin-converting enzyme gene insertion\/deletion, not bradykinin B2 receptor -58T\/C gene polymorphism, associated with angiotensin-converting enzyme inhibitor-related cough in Chinese female patients with non-insulin-dependent diabetes mellitus. Metabolism-Clinical and Experimental. 2001; 50: 1346\u20131350.","DOI":"10.1053\/meta.2001.27212"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Komajda M, Lapuerta P, Hermans N, Gonzalez-Juanatey JR, van Veldhuisen DJ, Erdmann E, et al. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. European Heart Journal. 2005; 26: 1653\u20131659.","DOI":"10.1093\/eurheartj\/ehi251"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"McCullough PA, Mehta HS, Barker CM, Van Houten J, Mollenkopf S, Gunnarsson C, et al. Mortality and guideline-directed medical therapy in real-world heart failure patients with reduced ejection fraction. Clinical Cardiology. 2021; 44: 1192\u20131198.","DOI":"10.1002\/clc.23664"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Peterson PN, Rumsfeld JS, Liang L, Hernandez AF, Peterson ED, Fonarow GC, et al. Treatment and risk in heart failure: gaps in evidence or quality? Circulation: Cardiovascular Quality and Outcomes. 2010; 3: 309\u2013315.","DOI":"10.1161\/CIRCOUTCOMES.109.879478"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Bhagat AA, Greene SJ, Vaduganathan M, Fonarow GC, Butler J. Initiation, Continuation, Switching, and Withdrawal of Heart Failure Medical Therapies During Hospitalization. JACC: Heart Failure. 2019; 7: 1\u201312.","DOI":"10.1016\/j.jchf.2018.06.011"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/24\/9\/10.31083\/j.rcm2409257","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T18:48:25Z","timestamp":1732733305000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/24\/9\/10.31083\/j.rcm2409257"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,18]]},"references-count":40,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023]]}},"alternative-id":["S1530-6550(23)00966-3"],"URL":"https:\/\/doi.org\/10.31083\/j.rcm2409257","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,18]]},"article-number":"257"}}