Get With The Guidelines–Heart Failure

Get With The Guidelines–Heart Failure
Name	Get With The Guidelines–Heart Failure
Founded	2005
Founder	American Heart Association
Location	United States
Focus	Cardiology; Heart failure

Get With The Guidelines–Heart Failure

Get With The Guidelines–Heart Failure is a quality improvement program developed to improve inpatient care for patients with heart failure by promoting adherence to evidence-based clinical practices. The initiative is administered by the American Heart Association and interfaces with hospitals, health systems, policymakers, and professional societies to standardize care pathways, performance measures, and patient education. It aligns with recommendations from specialty organizations and links to registry efforts that inform clinical benchmarking and research.

Overview

The program functions as a hospital-based quality improvement and clinical registry platform that aims to translate clinical trial results from studies led by investigators from institutions such as Harvard Medical School, Johns Hopkins University, Mayo Clinic, Cleveland Clinic, and Mount Sinai Health System into routine inpatient practice. It emphasizes guideline-directed medical therapy endorsed by groups including the American College of Cardiology, European Society of Cardiology, Heart Failure Society of America, National Heart, Lung, and Blood Institute, and the World Health Organization for populations seen at centers such as Massachusetts General Hospital, Brigham and Women’s Hospital, and regional systems like Kaiser Permanente. The program is designed to integrate with electronic health records at vendors such as EPIC Systems Corporation, Cerner Corporation, and MEDITECH to facilitate data capture.

History and Development

Get With The Guidelines–Heart Failure was launched in the 2000s as an extension of earlier AHA quality initiatives that included programs linked to stroke and myocardial infarction care, building on collaborative models used by institutions like Duke University Medical Center and University of California, San Francisco. Early development involved partnerships with federal agencies, academic centers, and professional organizations including the Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, and the Institute for Healthcare Improvement. Influential clinicians and researchers from programs at Stanford University School of Medicine, University of Pennsylvania Health System, and Vanderbilt University Medical Center contributed to guideline content and implementation strategy. Over time, revisions incorporated guideline updates from organizations such as the European Society of Cardiology and major randomized trials conducted by consortia including NIH-funded networks.

Program Components and Clinical Guidelines

Core components include standardized order sets, performance measures, discharge checklists, and patient education tools aligned with guideline recommendations from the American College of Cardiology and American Heart Association. Clinical guidance covers use of pharmacotherapies evaluated in landmark trials at centers like Columbia University Irving Medical Center and University of Oxford, such as angiotensin-converting enzyme inhibitors, beta-blockers, mineralocorticoid receptor antagonists, sacubitril/valsartan, and device therapy indications informed by bodies like the National Institute for Health and Care Excellence. The program also supports heart failure-specific metrics for comorbidity management (including diabetes guidance informed by trials at Joslin Diabetes Center), transitions of care protocols used in systems like Intermountain Healthcare, and palliative care integration modeled on programs at Hospice of the Valley and academic palliative teams.

Implementation and Participation

Participation involves hospital enrollment, multidisciplinary teams drawn from cardiology services at institutions such as Yale New Haven Hospital, nursing leadership from Mayo Clinic Hospital, pharmacy services informed by American Society of Health-System Pharmacists, and quality improvement staff trained by organizations like the Institute for Healthcare Improvement. Implementation strategies include clinical education sessions referencing landmark trials from The New England Journal of Medicine and guideline policy statements from the Journal of the American College of Cardiology and Circulation. Hospitals ranging from academic medical centers such as UCSF Medical Center to community hospitals and integrated delivery networks participate, with technical support for electronic data submission to the registry.

Outcomes and Impact on Patient Care

Published analyses from registry data and collaborations with academic centers including Duke University, University of Michigan, and Stanford Medicine have documented improvements in prescription rates for evidence-based medications, increased use of device therapies, and more consistent discharge instructions. Studies in journals such as JAMA, The Lancet, and Circulation that leveraged registry datasets reported associations between program participation and reductions in readmission rates, in-hospital mortality, and improved process measures similar to results seen in other condition-specific quality programs like those for stroke and acute myocardial infarction. The program has informed policy discussions at the Centers for Medicare & Medicaid Services and quality benchmarks used by accreditation bodies such as The Joint Commission.

Data Collection, Registry, and Quality Metrics

The registry component captures patient-level data including demographics, clinical characteristics, therapies, and outcomes, enabling benchmarking and research collaborations with academic partners such as University of California San Diego Health and Northwestern Medicine. Quality metrics include adherence to discharge medication bundles, counseling on self-care and follow-up, and risk-adjusted outcome measures aligned with performance frameworks from National Quality Forum and reporting programs sponsored by the Agency for Healthcare Research and Quality. Aggregated data have supported peer-reviewed publications and quality dashboards used by hospital leadership teams similar to reporting tools used by Agency for Healthcare Research and Quality initiatives.

Criticisms and Limitations

Critiques of the program have focused on potential selection bias because participating hospitals may differ from nonparticipating sites such as rural community hospitals, limitations in capturing longitudinal outpatient outcomes beyond the index hospitalization, and variable integration with diverse electronic health record systems like Allscripts and NextGen Healthcare. Concerns also include the potential for metric-driven care to emphasize process measures over individualized patient-centered decisions, challenges in generalizing findings from registry cohorts to international settings including NHS England or healthcare systems in Canada and Australia, and the resource intensity required for sustained participation that may disadvantage under-resourced institutions.

Category:Cardiology