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

Abdul Shakoor, Mireille E. Emans, the Rijnmond Heart Failure Network, Marco W.F. van Gent, Anneke Hendrix, Nikola Faber, Tirza S. Springeling, Liesbeth C. de Vette, Olivier C. Manintveld, Robert N. Denham, Chajja van de Meerendonk, Robert M.A. van der Boon, Jasper J. Brugts*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
22 Downloads (Pure)


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.

Original languageEnglish
Pages (from-to)2074-2083
Number of pages10
JournalESC heart failure
Issue number3
Publication statusPublished - Jun 2023

Bibliographical note

Funding Information:
CHAIN‐HF is an investigator‐initiated study. Database management, quality control, and data analyses are coordinated by the Erasmus Medical Center (Rotterdam, The Netherlands). The investigators will have full access to all of the data in this study. The study is partially supported by an independent research grant (investigator‐sponsored studies (ISS) programme) from Abbott. The sponsor had no role in the data extraction process or analyses, the writing of the manuscript, or the decision to submit the manuscript for publication.

Publisher Copyright:
© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.


Dive into the research topics of 'Regional management of worsening heart failure: rationale and design of the CHAIN-HF registry'. Together they form a unique fingerprint.

Cite this