Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Jun;10(3):2074-2083.
doi: 10.1002/ehf2.14354. Epub 2023 Mar 25.

Regional management of worsening heart failure: rationale and design of the CHAIN-HF registry

Abdul Shakoor  1 , Mireille E Emans  2 , Marco W F van Gent  3 , Anneke Hendrix  4 , Nikola Faber  5 , Tirza S Springeling  6 , Liesbeth C de Vette  7 , Olivier C Manintveld  1 , Robert N Denham  8 , Chajja van de Meerendonk  9   10 , Robert M A van der Boon  1 , Jasper J Brugts  1 ; Rijnmond Heart Failure Network
Affiliations
Multicenter Study

Regional management of worsening heart failure: rationale and design of the CHAIN-HF registry

Abdul Shakoor et al. ESC Heart Fail. 2023 Jun.

Abstract

Aims: Heart failure (HF) is a progressive disease in which periods of clinical stability are interrupted by episodes of clinical deterioration known as worsening heart failure (WHF). Patients who develop WHF are at high risk of subsequent death, rehospitalization, and excessive healthcare costs. As such, WHF could be seen as a separate disease stage and precursor of advanced HF. Whether WHF has a substantial health, societal, and economic impact evidence regarding its multifactorial nature and the specific barriers in treatment, including advanced HF therapies, remains scarce. The CHAIN-HF registry aims to describe the incidence, characteristics, current treatment, and outcomes of WHF. Additionally, it will promote structured regional collaboration and educate on increasing awareness for WHF and describe the implementation of guideline directed medical therapy and utilization of advanced HF therapies in a collaborative network.

Methods and results: The CHAIN-HF registry is a prospective, observational, and multicentre study from the collaborating hospitals (Rijnmond HF Network) in the Rotterdam area. Unselected and consecutive patients (irrespective of ejection fraction) with a WHF event will be included. Comprehensive data including demographics, co-morbidities, treatment, and in-hospital and post-discharge outcomes will be collected. Notably, data on socio-economic status, treatment decisions, and referral for advanced HF therapies will be included.

Conclusions: CHAIN-HF will be the first prospective, dedicated WHF registry in a collaborative network of hospitals that will provide robust real-world evidence on the incidence, characteristics, and outcomes of WHF. Moreover, it will provide information on of the value of regional collaboration to improve awareness and outcomes of WHF.

Keywords: Advanced heart failure therapies; Hub-and-spoke model; Medical treatment; Regional collaboration; Worsening heart failure.

PubMed Disclaimer

Conflict of interest statement

Dr Brugts has received speaker and consulting fees from Abbott, Novartis, Bayer, Boehringer, and AstraZeneca unrelated to this work. Furthermore, he reported an ISS study grand from Abbott. Dr Manintveld reported consulting fees from Abbott, AstraZeneca, Boehringer Ingelheim, and Novartis. Additionally, he is the president of the working group of heart failure of the Dutch Society of Cardiology. D. Emans reported speaker fees from Vifor international, AstraZeneca, Boehringer Ingelheim, and Novartis. She is also a study domain leader for heart failure in Check@home (study for population screening cardiovascular disease/renal disease/atrial fibrillation/heart failure).

Figures

Figure 1
Figure 1
Geographical distribution of the 11 participating hospitals in the CHAIN‐HF programme.
Figure 2
Figure 2
Representation of the hub‐and‐spoke principle. This figure represents the hub‐and‐spoke model in the CHAIN‐HF programme. In the centre of the figure is the hub centre (Erasmus University Medical Center) surrounded by the 10 spoke centres.
Figure 3
Figure 3
Study timeline. This figure shows the timeline of the CHAIN‐HF study.
See this image and copyright information in PMC

References

    1. Butler J, Yang M, Manzi MA, Hess GP, Patel MJ, Rhodes T, Givertz MM. Clinical course of patients with worsening heart failure with reduced ejection fraction. J Am Coll Cardiol. 2019; 73: 935–944. - PubMed
    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo‐Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, ESC Scientific Document Group , de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes‐Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa‐Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo‐Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42: 3599–3726. - PubMed
    1. Levy D, Kenchaiah S, Larson MG, Benjamin EJ, Kupka MJ, Ho KK, Murabito JM, Vasan RS. Long‐term trends in the incidence of and survival with heart failure. N Engl J Med. 2002; 347: 1397–1402. - PubMed
    1. Butler J, Braunwald E, Gheorghiade M. Recognizing worsening chronic heart failure as an entity and an end point in clinical trials. JAMA. 2014; 312: 789–790. - PubMed
    1. Greene SJ, Fonarow GC, Butler J. Risk profiles in heart failure: baseline, residual, worsening, and advanced heart failure risk. Circ Heart Fail. 2020; 13: e007132. - PubMed

Publication types