Featured Quality Research

The American Heart Association's (AHA) Get With The Guidelines® (GWTG) is a hospital-based quality improvement program designed to close the treatment gap in cardiovascular disease, heart failure, resuscitation and stroke. Our suite of quality improvement programs collects millions of patient records that allow investigator-led research using this data. The AHA greatly values clinical investigators and their research.

Each month we will spotlight the author of the newest Quality Improvement Research coming from the Get With The Guidelines Data Registries.  

Questions with the Experts

May 2020:

Marat Fudim, MD, MHS
Cardiovascular Fellow
Division of Cardiology
Duke University

Data Registry: Get With The Guidelines®-Heart Failure

Published Study: Representativeness of the PIONEER-HF Clinical Trial Population in Patients Hospitalized With Heart Failure and Reduced Ejection Fraction Circ HF 2020

When you started this study, what were you aiming to learn? 
"Sacubitril Valsartan is one of the newer agents that was added to the armamentarium of heart failure medical management. More recently, the PIONEER trial showed that inpatient initiation of the drug was safe and effective to improve a clinically significant biomarker and clinical outcomes. This trial was important since initiation of heart failure drugs in an inpatient setting has been shown to increase chances that patients end up on guideline directed medical therapy.  This leads to improved outcomes in the short and long term. Our study aimed to determine the representativeness of the PIONEER-HF trial among patients hospitalized for acute decompensated heart failure using real-world data."

Who was your target patient population and how did you study them? 
"We performed an observational study using the Get With The Guidelines®-Heart Failure registry linked to Medicare claims. We only included patients with heart failure and reduced ejection fraction (HFrEF). Next, we determined the proportion of patients meeting PIONEER-HF eligibility criteria (“PIONEER-HF eligible”) and also those meeting limited eligibility criteria (“actionable” cohort). We compared rates of HF readmissions and all-cause mortality.".

Did the study results turn out as you had expected or were you surprised with what you found? 
"We found that about one out of every five individuals (20.8%) met the PIONEER-HF trial inclusion and exclusion criteria. This was expected, since most clinical trials tend to intentionally narrow the study population. Relaxing the criteria to an “actionable” cohort increased the eligibility to 68.9% of all patients with HFrEF. Baseline characteristics and clinical outcomes at one year within the GWTG-HF cohorts indicated an all-over comparable but somewhat lower risk profile of patients eligible for PIONEER-HF as compared with patients with HFrEF encountered in routine practice.".

How do you see this study impacting the future of medicine and patient care? 
"The fact that patient characteristics and clinical outcomes in patients eligible for PIONEER-HF only modestly differ when compared with those encountered in routine practice, indicates that results from PIONEER-HF may be broadly generalizable. Our findings further support clinicians to apply guideline recommendations to optimize medical therapy (aka Sacubitril Valsartan) for their patients prior to discharge for their acute heart failure hospitalization.".


Adam Devore Headshot

April 2020:

Adam DeVore, MD, MHS
Heart Failure Cardiologist
Assistant Professor of Medicine,
Duke University Medical Center,
Duke Clinical Research Institute

Data Registry: Get With The Guidelines®-Heart Failure

Published Study: Testing for Coronary Artery Disease in Older Patients with New-Onset Heart Failure: Findings from Get With The Guidelines-Heart Failure Circ HF 2020

When you started this study, what were you aiming to learn? 
"Our main goal was to understand the proportion of patients that were receiving testing for coronary artery disease after a new diagnosis of heart failure. Among the patients that were receiving testing, we also wanted to know what factors were associated with this, such as age, left ventricular ejection fraction, etc. This is an important question for the heart failure community and the Get With The Guidelines® -Heart Failure program afforded a unique opportunity to address this". 

Who was your target patient population and how did you study them? 
"We performed an observational study using the Get With The Guidelines® -Heart Failure registry linked to Medicare claims. All patients were hospitalized with new-onset heart failure. We collected medical information on heart failure from the registry, as well as testing for coronary artery disease using Medicare claims from 90 days before to 90 days after the hospitalization".

Did the study results turn out as you had expected or were you surprised with what you found? 
"The findings suggest the rates of testing are low, <40%, for a large population of heart failure patients. This appears to be an opportunity to improve outcomes in patients with heart failure by treating one of the most common underlying causes, coronary artery disease, with medical therapy for coronary disease and/or revascularization".

How do you see this study impacting the future of medicine and patient care? 
"The next steps are to create and evaluate the impact of quality improvement interventions designed to improve the rates of testing for coronary artery disease".