CJC Open最新文献

{"title":"Medial Dissection Following Balloon Angioplasty in Peripheral Pulmonary Artery Stenosis Harbouring Homozygous RNF213 p.Arg4810Lys Variant","authors":"Takatoyo Kiko MD, PhD , Ryotaro Asano MD, PhD , Tomohiko Ishibashi MD, PhD , Jin Ueda MD , Akihiro Tsuji MD, PhD , Keiko Ohta-Ogo MD, PhD , Yoshikazu Nakaoka MD, PhD , Takeshi Ogo MD, PhD","doi":"10.1016/j.cjco.2024.11.011","DOIUrl":"10.1016/j.cjco.2024.11.011","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 2","pages":"Pages 161-165"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Multidisciplinary Cardiogenic Shock Team in a Nonacademic Canadian Heart Centre: An Implementation Study","authors":"Dana El-Mughayyar MSc ,&nbsp;Terrel Marshall BASc ,&nbsp;Kenneth D’Souza PhD ,&nbsp;Jeffrey B. MacLeod BSc ,&nbsp;Amanda McCoy BNRN ,&nbsp;Susan Morris BNRN Med ,&nbsp;Meaghan Smith MNRN ,&nbsp;Christopher W. White MD, PhD, FRCSC ,&nbsp;Shreya Sarkar PhD ,&nbsp;Keith R. Brunt PhD ,&nbsp;Jean-François Légaré MD, FRCPSC, CIP","doi":"10.1016/j.cjco.2024.11.007","DOIUrl":"10.1016/j.cjco.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>In this study we evaluated our ability to implement team-based cardiogenic shock (CS-Team), focussing on: 1) early screening; 2) CS-Team activation; and 3) use of invasive monitoring to guide therapy.</div></div><div><h3>Methods</h3><div>All patients admitted to the coronary care unit (CCU) over 12 months were screened for CS. A diagnosis of CS was made when both hypotension and hypoperfusion were present. The CS-Team was composed of the CCU attending, an interventional cardiologist, and a cardiac surgeon. Multivariate analysis was carried out with mortality as the outcome of interest.</div></div><div><h3>Results</h3><div>Screening was documented in 74% (1160 of 1562) of patients admitted to a critical care unit; of these, 1080 were not in CS. We identified 80 patients in CS (Society for Cardiovascular Angiography &amp; Interventions [SCAI] stages C-E), which represented 6.9% of all screened patients. Patients in CS had significantly higher in-hospital mortality (35% vs 2%, <em>P</em> &lt; 0.0001). CS-Team was activated in 35 of 80 patients (44%). CS-Team activation resulted in significantly greater use of invasive monitoring (pulmonary artery catheter [49% vs 7%, <em>P</em> &lt; 0.0001], cardiac catheterization [94% vs 76%, <em>P</em> &lt; 0.032], and mechanical circulatory support [51% vs 2%, <em>P</em> &lt; 0.001]). Independent predictors of mortality were severity of CS (SCAI grades D or E) (odds ratio [OR] 18.78, 95% confidence interval [CI] 4.89-96.65) and age, in years (OR 1.07, 95% CI 1.01-1.14), whereas CS-Team was not predictive of mortality (OR 0.66, 95% CI 0.16-2.41).</div></div><div><h3>Conclusions</h3><div>We found that: 1) early screening by frontline staff was feasible but had limitations (26% screening failure); 2) CS-Team activation appeared discretionary (limited activation to 45% of patients); and 3) CS-Team activation resulted in a significant increase in the use of invasive monitoring that helped guide therapy.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 2","pages":"Pages 231-238"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The COVID-19 Pandemic Did Not Negatively Impact Adherence to Cardiovascular Medications Among 548,601 Chronically Treated Patients in Alberta","authors":"Finlay A. McAlister MD, MSc ,&nbsp;Anamaria Savu PhD ,&nbsp;Luan Manh Chu PhD ,&nbsp;Douglas C. Dover PhD ,&nbsp;Padma Kaul PhD","doi":"10.1016/j.cjco.2024.10.014","DOIUrl":"10.1016/j.cjco.2024.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Studies have suggested that the COVID-19 pandemic negatively impacted patient adherence with chronic medications. We explored whether adherence patterns changed in patients chronically treated with cardiovascular drugs after onset of the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study we examined drug dispensation data for all adult Albertans who were chronic users of at least 1 cardiovascular drug class between 2017 and 2023. We calculated each patient’s proportion of days covered (PDC) for each drug class in the prepandemic phase (March 15, 2018 to March 14, 2020) and the pandemic phase (March 15, 2020 to March 14, 2022), and used generalized estimating equation logistic regression to estimate the effect of time period on achievement of good adherence (PDC &gt;0.8) after adjusting for age, sex, socioeconomic status, and comorbidities.</div></div><div><h3>Results</h3><div>Of 548,601 chronic users of at least 1 cardiovascular drug class between March 15, 2018 and March 14, 2022, 47.2% were women, the mean age was 62.3 years, and 55.4% had Charlson Comorbidity Index (CCI) scores of 0. The most frequently dispensed cardiovascular drugs were angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (67.6%) and statins (53.8%); the most frequent diagnoses were hypertension (77.2%), diabetes mellitus (30.6%), and ischemic heart disease (19.6%). Chronic users of cardiovascular drugs were more likely to have PDC &gt;0.8 during the pandemic than in the prepandemic period: 75.4% vs 72.8%, with adjusted odds ratios ranging from 1.05 (95% confidence interval 1.00-1.11) for mineralocorticoid receptor antagonists to 1.16 (95% confidence interval 1.15-1.17) for statins.</div></div><div><h3>Conclusions</h3><div>Chronic users of cardiovascular drugs exhibited better adherence during the COVID-19 pandemic than before the pandemic.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 2","pages":"Pages 203-210"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral Vein Pulsatility and Neurocognitive Disorder in Cardiac Surgery","authors":"Ali Hammoud RN, MSc ,&nbsp;Tanya Mailhot RN, PhD ,&nbsp;Melissa Parent MD ,&nbsp;Karel Huard MD ,&nbsp;Olivier Lachance MD ,&nbsp;Patrick Tawil MD ,&nbsp;Alexander Calderone MD ,&nbsp;Sylvie Levesque MSc ,&nbsp;Stéphanie Jarry RN, MSc ,&nbsp;William Beaubien-Souligny MD, PhD ,&nbsp;Étienne J. Couture MD ,&nbsp;André Y. Denault MD, PhD","doi":"10.1016/j.cjco.2024.11.002","DOIUrl":"10.1016/j.cjco.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Neurocognitive disorder and venous congestion are related in cardiac surgery. Femoral vein (FV) Doppler allows noninvasive assessment of venous congestion. This study aims to associate postoperative neurocognitive disorder in cardiac surgery with FV pulsatility.</div></div><div><h3>Method</h3><div>A secondary analysis was conducted using data from retrospective and prospective cohorts. FV Doppler and neurocognitive disorder were measured upon admission to the intensive care unit (ICU) after surgery. An index of FV pulsatility of ≥ 50% was considered abnormal. The presence of neurocognitive disorder was assessed using the Intensive Care Delirium Score Checklist (ICDSC). Descriptive statistical analyses and logistic regression were used to test the association between FV Doppler pulsatility and neurocognitive disorder.</div></div><div><h3>Results</h3><div>A total of 273 patients from both cohorts were analyzed, 155 (57%) patients had FV pulsatility indexes ≥ 50%. Abnormal pulsatile Doppler was associated with the presence of neurocognitive disorder compared with normal FV Doppler profile (57 vs 43%, odds ratio [OR], 1.73; 95% confidence interval [CI], 1.06-2.81). FV pulsatility was also associated with age, higher rate of stroke, prolongation of intubation duration and a longer ICU stay.</div></div><div><h3>Conclusions</h3><div>FV pulsatility is associated with the presence of neurocognitive disorder and postoperative complications in cardiac surgery. The FV Doppler technique is simple and fast, offering the potential to anticipate complications related to venous congestion, such as delirium. Future multicentre studies with larger samples will be necessary to consolidate these findings.</div></div><div><h3>Clinical Registration Number</h3><div><span><span>NCT04092855</span><svg><path></path></svg></span> and <span><span>NCT05038267</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 2","pages":"Pages 187-192"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of Inaccurate Blood Pressure Measurement on Hypertension Prevalence","authors":"Alexander A. Leung MD, MPH ,&nbsp;Swapnil Hiremath MD, MPH ,&nbsp;Jeanne V.A. Williams MSc ,&nbsp;Ross T. Tsuyuki BSc (Pharm), PharmD, MSc","doi":"10.1016/j.cjco.2024.10.011","DOIUrl":"10.1016/j.cjco.2024.10.011","url":null,"abstract":"<div><h3>Background</h3><div>The cornerstone of the management of hypertension is accurate measurement of blood pressure (BP). A recent study showed that more than one-half of home BP devices sold in Canada have no evidence of validation for accuracy. The purpose of this study was to model the implications of inaccurate BP measurements on diagnosis and control of hypertension.</div></div><div><h3>Methods</h3><div>We used data from the Canadian Health Measures Survey to model the effects of inaccurate BP devices by 5 or 10 mm Hg over or under the true BP value. Hypertension was defined as BP ≥ 140/90 mm Hg (or ≥130/80 mm Hg in those patients with diabetes).</div></div><div><h3>Results</h3><div>If both systolic and diastolic BP were overestimated by 10 mm Hg, the prevalence of hypertension would falsely increase by 50% to 63%, potentially leading to overtreatment of approximately 3.5 million Canadians. Conversely, the impact of underestimation of BP appeared minimal, but mostly because of design limitations of our study.</div></div><div><h3>Conclusions</h3><div>We found that overestimation of BP by only 10 mm Hg could lead to overtreatment of up to 3.5 million Canadians. Government should mandate the validation of BP devices before they can be sold; until then, clinicians and patients should be cautious in their selection of BP devices, using the Hypertension Canada Recommended Device Program to guide selection.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 2","pages":"Pages 239-246"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Patients with Myocardial Injury After Noncardiac Surgery: A Retrospective Chart Review","authors":"Michael Ke Wang MD ,&nbsp;Denise Sabac BHSc MSc ,&nbsp;Roshan Sadhak MD ,&nbsp;Amy Ajay MD ,&nbsp;Myles Benayon MD ,&nbsp;Flavia K. Borges MD, PhD ,&nbsp;Yevin Cha MD ,&nbsp;David Conen MD, MPH ,&nbsp;Michael Coomber MD, CCFP ,&nbsp;Katherine Fuller MD ,&nbsp;Diljit Gill MD ,&nbsp;Rahul Jayachandiran MD ,&nbsp;Carol Koubaesh MD ,&nbsp;Lekhini Latchupatula MD ,&nbsp;Sabreena Moosa MD ,&nbsp;Sandra Ofori MD, PhD ,&nbsp;Keerthana Pasumarthi MD ,&nbsp;Ameen Patel MD ,&nbsp;Saif Samari MD ,&nbsp;Steffen Blum MD, PhD ,&nbsp;Maura Marcucci MD, MSc","doi":"10.1016/j.cjco.2024.10.004","DOIUrl":"10.1016/j.cjco.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Myocardial injury after noncardiac surgery (MINS) is associated with an increased incidence of cardiac morbidity and mortality. Little is known about how these patients are managed.</div></div><div><h3>Methods</h3><div>We performed a single-centre retrospective chart review of patients referred to a postoperative clinic with the diagnosis of MINS. Patients were included if they attended the clinic at least once between September 2018 and December 2019. We extracted preoperative, in-hospital, and postdischarge data on cardiac investigations and medication use.</div></div><div><h3>Results</h3><div>Of the 152 patients with MINS who were included, 34% had a history of coronary disease before MINS. The median peak high-sensitivity troponin I (hsTnI) level was 122 ng/L (interquartile range, 51–259), and 78% had no associated ischemic symptoms or electrocardiographic changes. Patients underwent echocardiography and nuclear stress imaging in 87% and 30% of cases, respectively. Of those who had cardiac investigations performed and no prior history of coronary artery disease, 23% (19 of 84) had ≥ 1 regional wall-motion abnormality on echocardiogram, and 39% (13 of 34) had evidence of ischemia on nuclear stress imaging. More patients were prescribed an antithrombotic and lipid-lowering drug at discharge (79%) and at their final clinic visit (86%), compared to the number before surgery (30%). A total of 57% of patients had changes made to ≥ 1 cardiovascular medication during clinic follow-up.</div></div><div><h3>Conclusions</h3><div>Patients with MINS followed in a postoperative clinic frequently had abnormal cardiac investigations and received medical optimization. Our findings suggest that postoperative clinics may represent an opportunity for risk mitigation after MINS, a possibility that deserves further evaluation.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 1","pages":"Pages 103-109"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Ambulatory Continuous Inotropes as a Bridge to Recovery in Advanced Heart Failure Secondary to Amphetamine-Induced Cardiomyopathy","authors":"Asma Babar MD, MSc ,&nbsp;Bastien Vallée-Marcotte PhD ,&nbsp;Anton Savin MD ,&nbsp;Mathieu Bernier MD ,&nbsp;Kim O’Connor MD ,&nbsp;Mario Sénéchal MD","doi":"10.1016/j.cjco.2024.10.013","DOIUrl":"10.1016/j.cjco.2024.10.013","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 1","pages":"Pages 23-26"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Sudden Cardiac Death Risk Prediction Tool in Clinical Practice Through Electronic Health Records (INSERT-HCM Study Design)","authors":"Tanya Papaz HBA ,&nbsp;Emily Seto PhD ,&nbsp;Samantha J. Anthony PhD, MSW ,&nbsp;Sarah J. Pol MSc ,&nbsp;Robin Hayeems PhD ,&nbsp;Melanie Barwick PhD, CPsych ,&nbsp;Seema Mital MD","doi":"10.1016/j.cjco.2024.10.002","DOIUrl":"10.1016/j.cjco.2024.10.002","url":null,"abstract":"<div><div>Sudden cardiac death is a leading cause of mortality in children with hypertrophic cardiomyopathy (HCM). The PRecIsion Medicine in CardiomYopathy consortium developed a validated tool (PRIMaCY) for sudden cardiac death risk prediction to help with implantable cardioverter defibrillator shared decision-making, as recommended by clinical practice guidelines. The <strong>I</strong>mpleme<strong>n</strong>ting a <strong>S</strong>udden Cardiac D<strong>e</strong>ath <strong>R</strong>isk Assessment <strong>T</strong>ool in <strong>C</strong>hildhood <strong>HCM</strong> (INSERT-HCM) study aims to implement PRIMaCY into electronic health records (EHRs) and assess implementation determinants and outcomes.</div><div>INSERT-HCM is a prospective, multicentre, hybrid type-3 mixed-methods implementation study of an EHR-embedded risk calculator across Canadian pediatric hospitals. The Active Implementation Framework will inform a staged implementation process, with organization-based implementation teams facilitating the implementation technical installation and implementation process. PRIMaCY will be installed as a user-tested EHR-integrated tool and implemented in practice using an organization and provider-focused strategy at participating hospitals. Technical installation and implementation strategies will be optimized for each healthcare setting. The Implementation Outcomes Taxonomy will inform implementation outcomes. Back-end EHR data will assess tool adoption, penetration, and fidelity. The Consolidated Framework for Implementation Research will assess implementation determinants (facilitators and barriers), and sustainability in clinical practice will be explored.</div><div>INSERT-HCM will inform best practices for implementing an evidence-based digital health solution within hospital EHRs and clinical workflows to improve guideline-directed care. Developing an effective implementation strategy will inform the future dissemination of EHR-integrated digital health tools to the broader scientific and clinical community.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 1","pages":"Pages 46-52"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Big Heart, Small Shoes: Heart Failure in Systemic Lupus Erythematosus, More Than Lupus Cardiac Involvement","authors":"Xiaohang Liu MD ,&nbsp;Shenke Liu MD ,&nbsp;Yangzhong Zhou MD ,&nbsp;Mengzhuo Cao MD ,&nbsp;Hui Zhang MD ,&nbsp;Yining Wang MD ,&nbsp;Xinhui Ning MD ,&nbsp;Shuang Zhou MD ,&nbsp;Qian Wang MD ,&nbsp;Mengtao Li MD","doi":"10.1016/j.cjco.2024.09.016","DOIUrl":"10.1016/j.cjco.2024.09.016","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 1","pages":"Pages 19-22"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Canadian Heart Failure (CAN-HF) Registry: A Canadian Multicentre, Retrospective Study of Outpatients with Heart Failure","authors":"Dimitar Saveski MD, FRCPC ,&nbsp;Melanie Kok MSc, PhD ,&nbsp;Stephanie Poon MD, MSc, FRCPC ,&nbsp;Carlos Rojas-Fernandez PharmD ,&nbsp;Sean A. Virani MD, MSc, MPH, FRCPC ,&nbsp;George Honos MD, FRCPC ,&nbsp;Robert McKelvie MD, PhD, FRCPC","doi":"10.1016/j.cjco.2024.09.014","DOIUrl":"10.1016/j.cjco.2024.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Guideline-directed medical therapy (GDMT) reduces events in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Despite this impact, underutilization of GDMT persists. This report sought to describe HF management in Canadian outpatients treated at specialized HF clinics (HFCs).</div></div><div><h3>Methods</h3><div>The Canadian Heart Failure (CAN-HF) study was retrospective and observational, and it included 1775 patients from 6 Canadian outpatient HFCs, from the period January 2017-April 2020.</div></div><div><h3>Results</h3><div>We observed improvement in prescription rates in patients with HFrEF, between their first visit and their most-recent clinic visit, across all GDMT classes, in those who were followed at the HFC for ≥ 6 months. The largest prescription rate increases were observed for angiotensin receptor–neprilysin inhibitors and mineralocorticoid-receptor antagonists. However, more than half of the patients remained on angiotensin-converting enzyme inhibitors and/or angiotensin-receptor blockers, despite being symptomatic, according to their New York Heart Association class. Most patients (50%) were on triple therapy, as of their most-recent visit, with fewer (36%) on dual therapy, monotherapy (13%), or no GDMT (2%). Our data also suggest that patients who had been managed at the HFC for &gt; 6 months had higher prescription rates of GDMT and were on higher doses of GDMT, compared to those who were new to the clinic. For patients with HF with preserved ejection fraction, few patients were on candesartan and less than half were on a mineralocorticoid-receptor antagonist.</div></div><div><h3>Conclusions</h3><div>Our data from HFCs that in most cases were affiliated with academic centres compare favourably with data from other analyses of ambulatory patients with HFrEF, evidence that supports the use of a specialized patient-care model.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 1","pages":"Pages 1-9"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}