{"doi":"10.1016/j.jacadv.2023.100289","title":"A Computable Algorithm for Medication Optimization in Heart Failure With Reduced Ejection Fraction","abstract":"Guideline-directed medical therapy (GDMT) optimization can improve outcomes in heart failure with reduced ejection fraction. The objective of this study was to determine if a novel computable algorithm appropriately recommended GDMT. Clinical trial data from the GUIDE-IT (Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Failure) and HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trials were evaluated with a computable medication optimization algorithm that outputs GDMT recommendations and a medication optimization score (MOS). Algorithm-based recommendations were compared to medication changes. A Cox proportional-hazards model was used to estimate the associations between MOS and the composite primary end point for both trials. The algorithm recommended initiation of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blockers, and mineralocorticoid receptor antagonists in 52.8%, 34.9%, and 68.1% of GUIDE-IT visits, respectively, when not prescribed the drug. Initiation only occurred in 20.8%, 56.9%, and 15.8% of subsequent visits. The algorithm also identified dose titration in 48.8% of visits for angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and 39.4% of visits for beta-blockers. Those increases only occurred in 24.3% and 36.8% of subsequent visits. A higher baseline MOS was associated with a lower risk of cardiovascular death or heart failure hospitalization (HR: 0.41; 95% CI: 0.21-0.80; P = 0.009) in GUIDE-IT and all-cause death and hospitalization (HR: 0.61; 95% CI: 0.44-0.84; P = 0.003) in HF-ACTION. The algorithm accurately identified patients for GDMT optimization. Even in a clinical trial with robust protocols, GDMT could have been further optimized in a meaningful number of visits. The algorithm-generated MOS was associated with a lower risk of clinical outcomes. Implementation into clinical care may identify and address suboptimal GDMT in patients with heart failure with reduced ejection fraction.","journal":"JACC Advances","year":2023,"id":370985,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9558,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1130654,"name":"Aaron Sifuentes","orcid":null,"position":1,"is_corresponding":false},{"id":743419,"name":"David Cordwin","orcid":"0000-0002-7803-8717","position":2,"is_corresponding":false},{"id":1130283,"name":"Rachel Kuo","orcid":"0000-0002-6918-8916","position":3,"is_corresponding":false},{"id":999978,"name":"Brigid Rowell","orcid":"0000-0002-8469-899X","position":4,"is_corresponding":false},{"id":1130655,"name":"Juan J. Arzac","orcid":null,"position":5,"is_corresponding":false},{"id":1130656,"name":"Ken DeBacker","orcid":null,"position":6,"is_corresponding":false},{"id":1130657,"name":"Jessica Guidi","orcid":null,"position":7,"is_corresponding":false},{"id":246589,"name":"Scott L. Hummel","orcid":"0000-0002-0924-3135","position":8,"is_corresponding":false},{"id":667651,"name":"Todd M. Koelling","orcid":"0000-0001-5988-2405","position":9,"is_corresponding":false},{"id":272503,"name":"Michael P. Dorsch","orcid":"0000-0003-2910-1879","position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-07-19T01:15:41.237096Z","pmid":"38939592","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}