{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T08:04:16Z","timestamp":1784966656932,"version":"3.55.0"},"reference-count":64,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AstraZeneca and Advara Heartcare","award":["AU-16742"],"award-info":[{"award-number":["AU-16742"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Guidelines recommend patients with heart failure with reduced ejection fraction (HFrEF) receive four-pillar heart failure (4P-HF) therapy, which significantly reduces cardiac morbidity and mortality. However, implementing these guidelines effectively into clinical practice remains challenging. Methods: Patients with HFrEF on submaximal 4P-HF therapy were identified from a large, multicentre Cardiology network database using a natural language processing tool, supported by manual file review. A nurse-led, remotely delivered, medication uptitration program aimed to optimise therapy in this real-world cohort. Results: The final cohort included 2004 patients with a mean age of 72.7 \u00b1 11.6 years. Utilisation of 4P-HF increased from 11.1% at baseline to 49.8% post intervention, and each individual medication class increased significantly post intervention (all p &lt; 0.001). The largest increase was observed with the use of sodium\u2013glucose cotransporter 2 inhibitors, which rose from 17.3% to 73.9%, followed by mineralocorticoid receptor antagonists (51.6% to 65.7%), beta-blockers (88.4% to 97.0%), and angiotensin-converting enzyme inhibitors\/angiotensin receptor blockers\/angiotensin receptor blocker\u2013neprilysin inhibitors (89.8% to 96.4%). In patients on submaximal therapy, barriers were documented in all cases. Following medication optimisation, left ventricular ejection function (LVEF) improved significantly (38.5% \u00b1 10.8% vs. 42.5% \u00b1 11.7, p &lt; 0.001). Conclusions: This nurse-led, remotely delivered, medication optimisation program significantly improved the adoption of 4P-HF therapy and LVEF in patients with HFrEF. The program demonstrates a practical, scalable solution for the optimisation of HFrEF therapy across a large healthcare network.<\/jats:p>","DOI":"10.3390\/jcm14155371","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T10:55:37Z","timestamp":1753872937000},"page":"5371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Nurse-Led, Remote Optimisation of Guideline-Directed Medical Therapy in Patients with Heart Failure and Reduced Ejection Fraction Across Australia"],"prefix":"10.3390","volume":"14","author":[{"given":"Gabrielle","family":"Freedman","sequence":"first","affiliation":[{"name":"Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia"},{"name":"Advara HeartCare, East Melbourne, Melbourne, VIC 3002, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Racheal","family":"Watt","sequence":"additional","affiliation":[{"name":"Advara HeartCare, East Melbourne, Melbourne, VIC 3002, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9709-794X","authenticated-orcid":false,"given":"Enayet Karim","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Advara HeartCare, East Melbourne, Melbourne, VIC 3002, Australia"},{"name":"School of Public Health, Monash University, Melbourne, VIC 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Quinlan","sequence":"additional","affiliation":[{"name":"Advara HeartCare, East Melbourne, Melbourne, VIC 3002, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Eccleston","sequence":"additional","affiliation":[{"name":"Advara HeartCare, East Melbourne, Melbourne, VIC 3002, Australia"},{"name":"Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Driscoll","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia"},{"name":"Monash Health, Clayton, VIC 3800, Australia"},{"name":"Centre for Quality and Patient Safety Research\u2014Monash Health Partnership, Deakin University, Geelong, VIC 3220, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6578-1800","authenticated-orcid":false,"given":"James","family":"Theuerle","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0401-7202","authenticated-orcid":false,"given":"Leighton","family":"Kearney","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia"},{"name":"Advara HeartCare, East Melbourne, Melbourne, VIC 3002, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1093\/eurjhf\/hfp103","article-title":"The prognostic significance of heart failure with preserved left ventricular ejection fraction: A literature-based meta-analysis","volume":"11","author":"Somaratne","year":"2009","journal-title":"Eur. 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