ArticleMedical care2013
Reasons for not prescribing guideline-recommended medications to adults with heart failure.
Article in Medical care, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
What it found
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Who cites it
19 citing papers in PubMed, 39 citations in OpenAlex.
- Barriers and Facilitators to Heart Failure Guideline-Directed Medical Therapy in an Integrated Health System and Federally Qualified Health Centers: A Thematic Qualitative Analysis.Journal of general internal medicine · 2026Article
- Trends in prescribing optimal medical therapy at discharge following percutaneous coronary intervention in a tertiary care hospital in the UAE.Frontiers in cardiovascular medicine · 2025Article
- Polypharmacy and Guideline-Directed Medical Therapy Initiation Among Adults Hospitalized With Heart Failure.JACC. Advances · 2024Article
- Clinician challenges to evidence-based prescribing for heart failure and reduced ejection fraction: A qualitative evaluation.Journal of evaluation in clinical practice · 2023Article
- A machine learning evaluation of patient characteristics associated with prescribing of guideline-directed medical therapy for heart failure.Frontiers in cardiovascular medicine · 2023Article
- Guideline-led prescribing to ambulatory heart failure patients in a cardiology outpatient service.International journal of clinical pharmacy · 2021Article
- Signs, symptoms, and treatment patterns across serial ambulatory cardiology visits in patients with heart failure: insights from the NCDR PINNACLE® registry.BMC cardiovascular disorders · 2018Article
- Impaired renal function affects clinical outcomes and management of patients with heart failure.ESC heart failure · 2017Article
- Cardiovascular care guideline implementation in community health centers in Oregon: a mixed-methods analysis of real-world barriers and challenges.BMC health services research · 2017Article
- The Challenges of Measuring, Improving, and Reporting Quality in Primary Care.Annals of family medicine · 2017Article
- Association of β-Blockers With Functional Outcomes, Death, and Rehospitalization in Older Nursing Home Residents After Acute Myocardial Infarction.JAMA internal medicine · 2017Article
- How to best assess quality of drug treatment in patients with heart failure.European journal of clinical pharmacology · 2016Article
- Treatment Initiation Patterns, Modifications, and Medication Adherence Among Newly Diagnosed Heart Failure Patients: A Retrospective Claims Database Analysis.Journal of managed care & specialty pharmacy · 2016Article
- Barriers to Adoption of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure: A Mixed-Methods Study.Journal of the American Heart Association · 2016Article
- Temporal Trends and Hospital Variation in Mineralocorticoid Receptor Antagonist Use in Veterans Discharged With Heart Failure.Journal of the American Heart Association · 2015Article
- Medication Initiation Burden Required to Comply With Heart Failure Guideline Recommendations and Hospital Quality Measures.Circulation · 2015Article
- Compliance with clinical pathways for inpatient care in Chinese public hospitals.BMC health services research · 2015Article
- Assessing Nephrological Competence among Geriatricians: A Proof of Concept Internet Survey.PloS one · 2015Article
- "Salt in the Wound": Safety Net Clinician Perspectives on Performance Feedback Derived From EHR Data.The Journal of ambulatory care managementArticle
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundLittle is known about how often contextual factors such as patient preferences and competing priorities impact prescribing of guideline-recommended medications, or about the extent to which these factors are documented in medical records and available to performance measurement systems.
methodsMixed-methods study of 295 veterans aged 50 years and older in 4 VA health care systems who had systolic heart failure and were not prescribed a β-blocker and/or an angiotensin converting enzyme inhibitor or angiotensin-receptor blocker. Reasons for nontreatment were identified from clinic notes and from interviews with 62 primary care clinicians caring for these patients. These reasons were classified using a published taxonomy.
resultsAmong 295 patients not receiving guideline-recommended drugs for heart failure, chart review identified biomedical reasons for nonprescribing in 42%-58% of patients and contextual reasons in 11%-17%. Clinician interviews identified twice as many reasons for nonprescribing as chart review (mean 1.6 vs. 0.8 reasons per patient, P<0.001). In these interviews, biomedical reasons for nonprescribing were cited in 50%-70% of patients, and contextual reasons in 64%-70%. The most common contextual reasons were comanagement with other clinicians (32%-35% of patients), patient preferences and nonadherence (15%-24%), and clinician belief that the medication is not indicated in the patient (12%-20%).
conclusionsContextual reasons for not prescribing angiotensin converting enzyme inhibitor / angiotensin-receptor blockers and β-blockers are present in two thirds of patients with heart failure who did not receive these medications, yet are poorly documented in medical records. The structure of medical records should be improved to facilitate documentation of contextual reasons for not providing guideline-recommended care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.