Improving Heart Failure Quality of Care Over the First Twenty Years: The Get With the Guidelines-Heart Failure Program

Background: The Get With the Guidelines-Heart Failure program is a national quality improvement initiative that was established in 2005 with the goal of improving the quality of care for patients hospitalized with heart failure. Methods: We examined patient characteristics, adherence to achievement and quality measures, and in-hospital outcomes in patients hospitalized with heart failure among Get With the Guidelines-Heart Failure participating hospitals between 2005 and 2024. Measures were applied to eligible patients without documented contraindications. Multivariable regression analysis, adjusting for patient and hospital characteristics, was performed to assess temporal changes in individual measures and outcomes. Results: Over the first 20 years, the Get With the Guidelines-Heart Failure program has grown to include 1 561 093 patient records (median age, 73 [62-83], 47.4% women, median ejection fraction 45% [28%-58%]) and 819 participating hospitals. There was significant and sustained improvement in an all-or-none composite achievement metric, with an increase from 76.1% to 88.7% between 2005 and 2024 (adjusted odds ratio, 3.7 [95% CI, 3.5-4.0]; P<0.001). Rates of mineralocorticoid receptor antagonist prescriptions among eligible patients also increased substantially from 27.4% to 80.9% (adjusted odds ratio, 22.3 [95% CI, 20.2-24.6]; P<0.001). Meanwhile, prescriptions of new therapies such as angiotensin receptor-neprilysin inhibitors and sodium-glucose cotransporter-2 inhibitors reached rates of 67.3% and 78.2% in 2024, respectively. Sustained improvements were also seen for other achievement and quality measures, including postdischarge follow-up and prescription of anticoagulation for patients with atrial fibrillation or atrial flutter. Equity of care by social vulnerability index also improved over time for guideline-based therapies such as evidence-based β-blockers and mineralocorticoid receptor antagonists. In contrast, vaccination rates and use of implantable cardioverter defibrillators saw recent decreases. Conclusions: The Get With the Guidelines-Heart Failure program was associated with sustained improvements in key achievement and quality measures for patients hospitalized with heart failure during its initial 2 decades, with a notable rise in the prescription of guideline-directed medical therapies and rapid implementation of new medications.