{
  "abstract": "Background: Despite strong evidence supporting dapagliflozin 10 mg daily for heart failure with reduced ejection fraction, variation in prescribing practices persists.\n\nProject Rationale: Institutional review identified frequent use of non–guideline-supported dapagliflozin 5 mg dosing and demonstrated that inpatient dose selection strongly influenced discharge prescribing patterns.\n\nProject Summary: A multidisciplinary quality improvement intervention consisting of electronic medical record redesign, provider education, and pharmacist-led discharge verification was implemented on December 15, 2025. Among 124 preintervention patients, 83.9% received inpatient dapagliflozin 10 mg and 16.1% received 5 mg. Following intervention, guideline-concordant 10-mg prescribing increased to 92.0% and 5-mg prescribing decreased to 8.0%. Inpatient dose remained significantly associated with discharge prescribing behavior (P = 0.0467).\n\nTake-Home Messages: System-level workflow redesign improved adherence to guideline-concordant dapagliflozin prescribing and reduced non–evidence-based low-dose use. Similar implementation strategies may improve delivery of guideline-directed medical therapy in heart failure.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, HCA Florida Blake Hospital/USF Morsani College of Medicine GME Consortium, Bradenton, Florida, USA",
    "West Florida Division, HCA Healthcare Research and Innovation Department, Tampa, Florida, USA",
    "Department of Cardiovascular Disease, HCA Florida Blake Hospital/USF Morsani College of Medicine GME Consortium, Bradenton, Florida, USA",
    "Department of Nephrology, HCA Florida Blake Hospital/USF Morsani College of Medicine GME Consortium, Bradenton, Florida, USA"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ahmad Karzoun"
    },
    {
      "affs": [
        0
      ],
      "name": "Hamza Alkowatli"
    },
    {
      "affs": [
        1
      ],
      "name": "Olu Oyesanmi"
    },
    {
      "affs": [
        2
      ],
      "name": "Robert Subbiondo"
    },
    {
      "affs": [
        3
      ],
      "name": "Hakan R. Toka"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/erbmvfmc5x6ny.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jaccas.2026.109545",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13728399/",
  "id": "erbmvfmc5x6ny",
  "issns": [
    "2666-0849"
  ],
  "landing_url": "https://doi.org/10.1016/j.jaccas.2026.109545",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Outcomes and Quality"
    ],
    [
      "heading",
      "Quality Improvement Projects"
    ],
    [
      "openalex",
      "2705|Heart Failure Treatment and Management"
    ]
  ],
  "openalex": "W7213429842",
  "pdf_url": null,
  "pmcid": "PMC13728399",
  "pmid": "42752027",
  "published": "2026-09-16",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/erbmvfmc5x6ny.ris",
  "sources": [
    {
      "first_seen": "2026-11-07T12:21:24Z",
      "native_id": "PMC13728399",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.jaccas.2026.109545"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Heart Failure Treatment and Management",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Improving Dapagliflozin Dosing in Heart Failure Through System-Level Quality Improvement",
  "title_text": "Improving Dapagliflozin Dosing in Heart Failure Through System-Level Quality Improvement",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:21:24Z",
  "url": "https://research.draconitic.com/paper/erbmvfmc5x6ny",
  "venue": "JACC Case Reports",
  "versions": []
}