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The period following heart failure hospitalization (HFH) is a vulnerable time with high rates of death or recurrent HFH.OBJECTIVE To evaluate clinical characteristics, outcomes, and treatment response to vericiguat according to prespecified index event subgroups and time from index HFH in the Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (VICTORIA) trial. DESIGN, SETTING, AND PARTICIPANTSAnalysis of an international, randomized, placebo-controlled trial. All VICTORIA patients had recent (<6 months) worsening HF (ejection fraction <45%). Index event subgroups were less than 3 months after HFH (n = 3378), 3 to 6 months after HFH (n = 871), and those requiring outpatient intravenous diuretic therapy only for worsening HF (without HFH) in the previous 3 months (n = 801). Data were analyzed between May 2, 2020, and May 9, 2020.INTERVENTION Vericiguat titrated to 10 mg daily vs placebo. MAIN OUTCOMES AND MEASURESThe primary outcome was time to a composite of HFH or cardiovascular death; secondary outcomes were time to HFH, cardiovascular death, a composite of all-cause mortality or HFH, all-cause death, and total HFH. RESULTS Among 5050 patients in the VICTORIA trial, mean age was 67 years, 24% were women, 64% were White, 22% were Asian, and 5% were Black. Baseline characteristics were balanced between treatment arms within each subgroup. Over a median follow-up of 10.8 months, the primary event rates were 40.9, 29.6, and 23.4 events per 100 patient-years in the HFH at less than 3 months, HFH 3 to 6 months, and outpatient worsening subgroups, respectively. Compared with the outpatient worsening subgroup, the multivariable-adjusted relative risk of the primary outcome was higher in HFH less than 3 months (adjusted hazard ratio, 1.48; 95% CI, 1.27-1.73), with a time-dependent gradient of risk demonstrating that patients closest to their index HFH had the highest risk. Vericiguat was associated with reduced risk of the primary outcome overall and in all subgroups, without evidence of treatment heterogeneity. Similar results were evident for all-cause death and HFH. Addtionally, a continuous association between time from HFH and vericiguat treatment showed a trend toward greater benefit with longer duration since HFH. Safety events (symptomatic hypotension and syncope) were infrequent in all subgroups, with no difference between treatment arms.CONCLUSIONS AND RELEVANCE Among patients with worsening chronic HF, those in closest proximity to their index HFH had the highest risk of cardiovascular death or HFH, irrespective of age or clinical risk factors. The benefit of vericiguat did not differ significantly across the spectrum of risk in worsening HF.

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Purpose -The purpose of this study is to investigate the perceived importance of soft skills for hotel employees, their willingness to use electronic learning (e-learning) as a training tool to improve their soft skills, and the impact of hotel employees' individual characteristics (i.e. motivation, self-efficacy, technology anxiety) on their intentions to use e-learning across different age groups. Design/methodology/approach -The sample was randomly selected from hotel employees working at various upscale international chain hotels in South Korea. The data were analyzed using structural equation modeling (SEM) to simultaneously measure the impact of four independent variables on the intention to use e-learning for both younger and older learners. Findings -The analysis revealed that responsibility, self-esteem, sociability, and working with diverse groups were rated more important by younger hotel employees. The results suggest that learners who have higher extrinsic motivations in using e-learning will be more likely to use e-learning. However, the other variables (i.e. technology anxiety, self-efficacy, and intrinsic motivation) did not significantly affect the intention to use e-learning.Research limitations/implications -The findings are practical for hotel managers/trainers, because they can focus on external rewards instead of internal rewards to motivate employees to use e-learning. Age did not have a moderating effect between technology anxiety and the intention to use e-learning. Since the respondents tend to be younger and have a higher standard of education compared with those of the general population, they may more accurately represent hotel employees at upscale or international chain hotels. Originality/value -The study proposes a framework to examine the impact of hotel employees' individual characteristics on their intention to use e-learning. The study also validates some relationships that have shown inconsistent results in previous studies. Future research could employ qualitative studies to investigate underlying dimensions of the variables tested in this study.

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