{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:44:15Z","timestamp":1793832255863,"version":"4.6.1"},"reference-count":31,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Jeroen Bosch Ziekenhuis","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"University Medical center Utrecht","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Heart failure is one of the leading causes of hospitalization in older adults. Guideline-directed medical therapy (GDMT) reduces the risk of decompensation and hospitalization, though it is challenging to implement GDMT in this group. Therefore, this study evaluated adherence to the 2021 ESC heart failure guideline in older patients and explored reasons for guideline deviations. Methods: A retrospective cohort study was performed in older patients (70+ years) with decompensated heart failure (ejection fraction &lt; 50%) admitted to the cardiology or geriatrics department at a tertiary hospital (May 2022\u2013September 2023). Data on GDMT-drug use, dosage, and reasons for guideline deviations were collected at discharge and three months post-discharge. Additionally, associations between GDMT non-adherence and factors such as age, frailty, comorbidities, and admission specialty were analyzed. Results: A total of 60 patients were included (mean age 79 years, 40% women, median EF 34%). The four GDMT drugs were prescribed to 15% of patients at discharge and 26% at follow-up, and 3% of the patients received the target dose for all drugs. Older patients (&gt;80 years) received GDMT less frequently at discharge compared to younger patients (4% vs. 26%, p = 0.03). Though this difference was resolved at follow-up. The other studied factors were not significantly associated with GDMT adherence. Common reasons for guideline deviations were adverse effects, contraindications, reduced life expectancy, and postponed treatment. Conclusions: Adherence to GDMT in older heart failure patients is low due to several reasons, such as relevant contraindications. Physicians should carefully balance the risks and benefits of the guideline versus individual benefit, considering life expectancy and individual care goals.<\/jats:p>","DOI":"10.3390\/jcm14196928","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T09:12:23Z","timestamp":1759223543000},"page":"6928","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Adherence to Guideline-Directed Medical Therapy in Hospitalized Older People with Heart Failure at Discharge and 3-Month Follow-Up"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2682-6359","authenticated-orcid":false,"given":"Renee C. M. A.","family":"Raijmann","sequence":"first","affiliation":[{"name":"Department of Geriatrics, UMC Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands"},{"name":"Department of Geriatrics, Jeroen Bosch Ziekenhuis, 5223 GZ \u2018s-Hertogenbosch, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7123-6560","authenticated-orcid":false,"given":"Melanie","family":"Haverkamp","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, UMC Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manon G.","family":"van der Meer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, UMC Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5778-5759","authenticated-orcid":false,"given":"Wilma","family":"Knol","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, UMC Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheyenne C. S.","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, UMC Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina J. P. W.","family":"Keijsers","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Jeroen Bosch Ziekenhuis, 5223 GZ \u2018s-Hertogenbosch, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marielle H.","family":"Emmelot-Vonk","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, UMC Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0938-6232","authenticated-orcid":false,"given":"Huiberdina L.","family":"Koek","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, UMC Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.hfc.2017.02.001","article-title":"Epidemiology, Pathophysiology, and Prognosis of Heart Failurein Older Adults","volume":"13","author":"Dharmarajan","year":"2017","journal-title":"Heart Fail. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cger.2006.08.001","article-title":"Epidemiology, pathophysiology, and prognosis of heart failure in the elderly","volume":"23","author":"Thomas","year":"2007","journal-title":"Clin. Geriatr. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1007\/s10741-023-10325-2","article-title":"Guideline-directed medical therapy for HFrEF sequencing strategies and barriers for life-saving drug therapy","volume":"28","author":"Malgie","year":"2023","journal-title":"Heart Fail. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1007\/s40266-018-0581-z","article-title":"Lower Prescription Rates in Centenarians with Heart Failure and Heart Failure and Kidney Disease Combined: Findings from a Longitudinal Cohort Study of Very Old Patients","volume":"35","author":"Schmidt","year":"2018","journal-title":"Drugs Aging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1002\/ejhf.2483","article-title":"Use of evidence-based therapy in heart failure with reduced ejection fraction across age strata","volume":"24","author":"Stolfo","year":"2022","journal-title":"Eur. J. Heart Fail."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1002\/ehf2.14114","article-title":"The interaction between physical frailty and prognostic impact of heart failure medication in elderly patients","volume":"10","author":"Abe","year":"2023","journal-title":"ESC Heart Fail."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1002\/ehf2.14163","article-title":"Frailty interferes with the guideline-directed medical therapy in heart failure patients with reduced ejection fraction","volume":"10","author":"Hamada","year":"2023","journal-title":"ESC Heart Fail."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/j.cjco.2022.08.003","article-title":"Use of Guideline-Directed Medical Therapy in Patients Aged \u2265 65 Years After the Diagnosis of Heart Failure: A Canadian Population-Based Study","volume":"4","author":"Wahid","year":"2022","journal-title":"CJC Open."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1001\/archinternmed.2011.31","article-title":"The persistent exclusion of older patients from ongoing clinical trials regarding heart failure","volume":"171","author":"Cherubini","year":"2011","journal-title":"Arch. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2485","DOI":"10.1111\/jgs.18343","article-title":"The association between frailty and the risk of medication-related problems among community dwelling older adults in Europe","volume":"71","author":"Ye","year":"2023","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_12","first-page":"290","article-title":"Polypharmacy in older heart failure patients: A multidisciplinary approach","volume":"19","author":"Sukumar","year":"2022","journal-title":"Comorbidities"},{"key":"ref_13","first-page":"725","article-title":"Care Gaps in adherence to heart failure guidelines: Clinical inertia or physiological limitations?","volume":"8","author":"Jarjour","year":"2020","journal-title":"Heart Fail."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.jacc.2018.05.023","article-title":"Are Guidelines Merely Suggestions?","volume":"72","author":"Jefferies","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1007\/s12471-020-01421-1","article-title":"Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: An analysis of the CHECK-HF registry","volume":"28","author":"Linssen","year":"2020","journal-title":"Neth. Heart J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3352","DOI":"10.1002\/ehf2.14524","article-title":"A scoring evaluation for the practical introduction of guideline-directed medical therapy in heart failure patients","volume":"10","author":"Matsukawa","year":"2023","journal-title":"ESC Heart Fail."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1007\/s41999-020-00370-7","article-title":"Validation of the Clinical Frailty Scale for retrospective use in acute care","volume":"11","author":"Stille","year":"2020","journal-title":"Eur. Geriatr. Med."},{"key":"ref_18","unstructured":"World Health Organization (2024). Anatomical Therapeutic Chemical (ATC) Classification, World Health Organization."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/NCQ.0000000000000301","article-title":"The Johns Hopkins Fall Risk Assessment Tool: A Study of Reliability and Validity","volume":"33","author":"Poe","year":"2018","journal-title":"J. Nurs. Care Qual."},{"key":"ref_21","unstructured":"Mair, A., Donaldson, L., Kelley, E., Hill, S., Dhingra-Kumar, N., Garner, S., Cherian, J.J., Etzel, D., Hakkinen, M., and Paget, D. (2019). Medication Safety in Polypharmacy, World Health Organization."},{"key":"ref_22","unstructured":"IBM Corp (2017). IBM SPSS Statistics for Windows, Version 29.0, IBM Corp."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1002\/ejhf.3267","article-title":"Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients: First data from the TITRATE-HF study","volume":"26","author":"Malgie","year":"2024","journal-title":"Eur. J. Heart Fail."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Araujo, C.S., Marco, I., Restrepo-Cordoba, M.A., Vila Costa, I., Perez-Villacastin, J., and Goirigolzarri-Artaza, J. (2024). An observational study of evidence-based therapies in older patients with heart failure with reduced ejection fraction: Insights from a dedicated heart failure clinic. J. Clin. Med., 13.","DOI":"10.3390\/jcm13237171"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.cjco.2023.01.002","article-title":"Use of Guideline-Directed Medical Therapy in Patients Aged 80 Years or Older with Heart Failure with Reduced Ejection Fraction","volume":"5","author":"Barry","year":"2023","journal-title":"CJC Open"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1007\/s00392-020-01607-y","article-title":"Medical treatment of octogenarians with chronic heart failure: Data from CHECK-HF","volume":"109","author":"Linssen","year":"2020","journal-title":"Clin. Res. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3110","DOI":"10.1111\/jgs.18481","article-title":"Frailty and uptake of angiotensin receptor neprilysin inhibitor for heart failure with reduced ejection fraction","volume":"71","author":"Lee","year":"2023","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.ijcard.2021.09.013","article-title":"Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry","volume":"343","author":"Kapelios","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/S0140-6736(22)02076-1","article-title":"Safety, tolerability, and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): A multinational, open-label, randomised trial","volume":"400","author":"Mebazaa","year":"2022","journal-title":"Lancet"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"afad254","DOI":"10.1093\/ageing\/afad254","article-title":"Sodium-glucose cotransporter-2 inhibitors (SGLT2) in frail or older people with type 2 diabetes and heart failure: A systematic review and meta-analysis","volume":"53","author":"Aldafas","year":"2024","journal-title":"Age Ageing"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1002\/ehf2.15223","article-title":"SGLT2i reduce arhythmic events in heart failure patients with cardiac implantable electronic devices","volume":"12","author":"Mariani","year":"2025","journal-title":"ESC Heart Fail."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6928\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T09:53:04Z","timestamp":1759225984000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6928"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":31,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14196928"],"URL":"https:\/\/doi.org\/10.3390\/jcm14196928","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,30]]}}}