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BACKGROUND: The foundation for managing heart failure with reduced ejection fraction (HFrEF) is adherence to guidelinedirected medical therapy. Finding an association between medication adherence and patients' health status (their symptoms, function, and quality of life) can be used to underscore its importance to patients. METHODS: The association of self-reported medication adherence in US outpatients with HFrEF enrolled in the Change the Management of Patients with Heart Failure registry from 2015 to 2017 was compared with their health status at baseline and 12 months later. A secondary analysis of changes in adherence between baseline and 6 months with 6-month health status was also performed. Medication adherence was assessed with the self-reported 4-item Morisky-Green-Levine Medication Adherence Scale, with scores ≥1 classified as nonadherent. The primary health status outcome was the diseasespecific 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OS; range, 0-100; higher is better). Robust linear regression models adjusted for confounders were used. RESULTS: After excluding those who died (n=316) or did not provide 12-month KCCQ (n=1285), 3495 outpatients with HFrEF were included, of whom 1108 (31.7%) reported being nonadherent. Nonadherent participants were younger, had significantly worse baseline health status (-5.83-point difference; P<0.001), and showed less improvement at 12 months (-1.7-point difference in mean change; P=0.017) than adherent participants. Among nonadherent patients at baseline, those whose adherence improved trended toward greater 6-month health status improvements than those remaining nonadherent (fully adjusted difference of 2.52 points; P=0.054). CONCLUSIONS: In HFrEF, medication nonadherence was associated with worse health status and less improvement over the following year. Improvements in adherence were associated with better health status than remaining nonadherent, underscoring the importance of supporting adherence with guideline-directed medical therapy in patients with HFrEF. [ABSTRACT FROM AUTHOR]

Background: The subcutaneous ICD (S‐ICD) is a viable alternative to transvenous ICD and avoids intravascular complications in patients without a pacing indication. The outcomes of S‐ICD implantation are uncertain in patients with prior sternotomy. Objective: We aim to compare the implant techniques and outcomes with S‐ICD implantation in patients with and without prior sternotomy. Methods: Multicenter retrospective cohort study including adult patients with an S‐ICD implanted between January 2014 and June 2020. Outcomes were compared between patients with and without prior sternotomy. Results: Among the 212 patients (49 ± 15 years old, 43% women, BMI 30 ± 8 kg/m2, 68% primary prevention, 30% ischemic cardiomyopathy, LVEF median 30% IQR 25%–45%) who underwent S‐ICD implantation, 47 (22%) had a prior sternotomy. There was no difference in the sensing vector (57% vs. 53% primary, p = 0.55), laterality of the S‐ICD lead to the sternum (94% vs. 96% leftward, p = 0.54), or the defibrillation threshold (65 ± 1.4 J vs. 65 ± 0.8 J, p = 0.76) with versus without prior sternotomy. The frequency of 30‐day complications was similar with and without prior sternotomy (n = 3/47 vs. n = 15/165, 6% vs. 9%, p = 0.56). Over a median follow‐up of 28 months (IQR 10–49 months), the frequency of inappropriate shocks was similar between those with and without prior sternotomy (n = 3/47 and n = 16/165, 6% vs. 10%, p = 0.58). Conclusion: Implantation of an S‐ICD in patients with prior sternotomy is safe with a similar risk of 30‐day complications and inappropriate ICD shocks as patients without prior sternotomy. [ABSTRACT FROM AUTHOR]