AHA heart failure registry making a major impact after 20 years
Twenty years after its launch, the Get With The Guidelines-Heart Failure (GWTG-HF) registry from the American Heart Association (AHA) has grown into one of the nation's most influential cardiovascular databases, helping accelerate the adoption of guideline-directed medical therapy (GDMT) while generating evidence that has reshaped heart failure care.
Since its inception in 2005, the registry has collected more than 1.6 million patient records from more than 800 hospitals, representing about 60% of U.S. hospitals. The database has produced more than 150 peer-reviewed publications and is increasingly being used to support implementation science, registry-based clinical trials and long-term outcomes research.
"What started as a quality improvement initiative has led to substantially better processes of care and, most likely, improved survival, fewer symptoms and a tremendous learning platform," Clyde W. Yancy, MD, MSc, chief of cardiology and professor of medicine at Northwestern University, said in a video interview with Cardiovascular Business.
He added that the registry was created to solve a longstanding challenge in medicine: the fact that it often takes years for clinical evidence to truly influence changes in daily practice.
"When we launched Get With The Guidelines, it often took 17 years for new discoveries to become routine care," he said. "The goal was simply to help clinicians get with the guidelines."
Instead of relying solely on education, participating hospitals receive regular feedback on their performance, allowing care teams to benchmark themselves against national standards and identify opportunities for improvement.
Stephen Greene, MD, a heart failure cardiologist at Duke University Medical Center, said the approach has produced measurable gains in the use of evidence-based therapies. One example is mineralocorticoid receptor antagonists (MRAs), a key component of GDMT. Registry data show use among eligible patients increased from roughly 25% in 2005, to approximately 80% in 2024.
"We're seeing widespread, major improvements in the use of these disease-modifying, life-saving therapies," Greene said.
Beyond improving bedside care, the registry also has become an important research resource. The data have supported studies that influence international clinical practice while also serving as a training ground for early-career investigators.
"This is not just about improving patient care," Greene said. "It's also about disseminating knowledge and mentoring the next generation of cardiovascular researchers."
Yancy noted that GWTG-HF findings are now routinely cited around the world as benchmarks for heart failure management.
Despite two decades of progress, both physicians emphasized that heart failure remains among the most costly chronic diseases in Medicare, with high mortality and frequent hospital readmissions. They said further improvements in GDMT adoption remain essential.
"We've made substantial improvements, but we can do even better," Greene said. "We have to treat heart failure with everything we've got."
The registry is also expanding beyond measuring inpatient care. Yancy said researchers are increasingly linking anonymized patient records to evaluate longitudinal outcomes, including follow-up visits and 30-day readmissions. Early analyses have shown that timely outpatient follow-up after hospitalization can significantly reduce readmission risk.
The next phase of the registry will leverage those longitudinal data alongside data science, informatics and randomized registry-based clinical trials to generate evidence more efficiently and speed implementation of new therapies.
Yancy said the success of the registry reflects a broader shift in medicine's view of quality improvement.
"Twenty years ago, quality improvement wasn't always viewed as serious science," he said. "Today, we've built a national network that recognizes improving care delivery is one of the most effective ways to improve outcomes for patients with heart failure."
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]