{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:28:31Z","timestamp":1786649311351,"version":"build-2736575974"},"reference-count":72,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite robust evidence and strong recommendations supporting the incremental and dose-related benefit of combined neurohormonal blockers (guideline\u2010directed medical therapy [GDMT]) in heart failure with reduced ejection fraction (HFrEF), real-world data shows significant gaps in uses and\/or dosing of these therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Rationale:<\/jats:title>\n                    <jats:p>As heart failure (HF) hospitalization is viewed as an opportunity for the initiation and optimization of HF life-saving medications and the paucity of data exploring this important issue in Yemen, the current study aims to fill this gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The objective of this study was to evaluate the use, number, and dose optimization of the GDMT in a cohort of hospitalized patients with HFrEF in Yemen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>We included 1408 Yemeni patients with available ejection fraction (EF) enrolled in the Gulf CARE registry from February to November 2012. In this analysis, we included only four classes of GDMT, renin-angiotensin system inhibitors (RASi), evidence-based beta-blockers, and mineralocorticoid receptor antagonist (MRA). Each drug dose was converted to the equivalent daily dose of a selected representative drug. We explored the prescription of these drugs either separately or in combination and the target dose (TD) achievement for each drug at admission and discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among the1408 patients recruited, 916 patients (65%) were males and mean age was 53.5 \u00b1 15.4 years, 53% (n = 748) presented with HFrEF (EF &lt; 40%), 21% (n = 299) with HFpEF (EF \u2265 50%), and 26% (n = 361) with HFmrEF (Heart failure with mildly reduced ejection fraction) (EF 40-49%). Beta-blockers, renin-angiotensin system inhibitors, and MRA were prescribed to 28% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 400), 51% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 716), and 10% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 143) at baseline and 69.5% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 978), 82% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1157), and 59% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 831) on discharge, respectively. The rate of TD achievement was (0.0% vs. 3.6% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 35]) for beta-blockers and (0.279% [\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 2] vs. 1.5% [\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 17]) for renin-angiotensin system inhibitors on baseline and discharge, respectively. Among 748 patients with HFrEF, 36% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 270) were not receiving any GDMT at baseline, while triple therapy was prescribed to 10% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 74) at baseline and 61.5% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 460) on discharge.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A substantial gap in GDMT implementations with both underutilization and low TD achievement in patients with HFrEF in Yemen.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/heartviews.heartviews_152_24","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T06:00:44Z","timestamp":1752732044000},"page":"7-18","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["In-hospital Utilization and Dose Optimization of Guideline-Directed Medical Therapies among Acute Heart Failure Yemeni Patients"],"prefix":"10.4103","volume":"26","author":[{"given":"Adnan","family":"Al-Radhi","sequence":"first","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine and Health Sciences, Sana\u2019a University, Sana\u2019a, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulkafi","family":"Shujaa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine and Health Sciences, Sana\u2019a University, Sana\u2019a, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Alsagheer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine and Health Sciences, Sana\u2019a University, Sana\u2019a, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taha","family":"Al-Maimoony","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine and Health Sciences, Sana\u2019a University, Sana\u2019a, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Al-Motarreb","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine and Health Sciences, Sana\u2019a University, Sana\u2019a, 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