Systematic tracking and registry for understanding clinical trajectories for hospitalized adults with heart failure with reduced ejection fraction: method and rationale for STRUCTURE-HF.

BACKGROUND: Current guidelines for heart failure treatment advocate for use of quadruple medical therapy (QMT), consisting of four pharmacologic classes. In clinical practice, the utilization of quadruple medical therapy within our health system is not currently clear. We present the design and rationale of the STRUCTURE-HF registry. OBJECTIVES: To provide an understanding of real-world usage of quadruple medical therapy within a non-academic hospital system setting for adults admitted to the hospital with heart failure with reduced ejection fraction. METHODS: This registry is anticipated to include 8000 to 10,000 patients admitted to five hospitals in a health system located in the Pacific Northwest. A retrospective review will be conducted with data collected including demographic data, laboratory values, preadmission and discharge medication utilization, and pertinent medical history. RESULTS: The primary endpoint of interest is the percentage of eligible patients on QMT at discharge. Secondary endpoints of interest include: 1) the percentage of eligible patients on QMT on admission and 2) of those participants eligible for QMT at discharge, but not prescribed, which GDMT medications were not prescribed CONCLUSION: STUCTURE-HF is a real-world, multicenter, observational chart review registry that will provide real-world usage data on contemporary QMT utilization in a non-academic health system. IMPLICATIONS: Establishing a baseline of QMT utilization will allow for future quality improvement efforts to have a basis for comparison as well as regional and national benchmarking of healthcare system performance.