Jordan Heart Failure Registry (JoHFR): Key Insights and Clinical Implications
Jordan Heart Failure Registry (JoHFR): Key Insights and Clinical Implications
Presented by:
Dr. Hadi Abu-Hantash
Heart Failure Manager, Working Group (JCS)
Source: JCS Heart Failure Conference 2025 – JoHFR Final Slides
Keynotes:
1. Study Design and Scope
• First national, multicenter registry capturing real-world data from 21 healthcare centers (university, public, and private).
• Study period: July 2021 – February 2023.
• Patients enrolled: 2,151 (1,531 chronic HF; 387 acute-on-chronic; 233 de novo HF).
• Represents the largest structured effort to characterize heart failure and benchmark it against ESC-HF Pilot and AHA/ACC GWTG-HF registries.
2. Clinical Profile of Patients
• Mean LVEF: 38.1 ± 12.7 %; approximately 59 % had LVEF ≤ 40 %.
• Hypertension: 80.7 %.
• Atherosclerotic CVD: 80.6 %.
• Diabetes: 69.2 %.
• Obesity: 36.6 %.
• Smoking: 31 %.
• Mean age: 66 years (27 % below 60 years).
Comparative Context:
• ESC-HF Pilot: mean age 67–70 years; diabetes 29–35 %; ischemic etiology ≈ 45–50 %.
• AHA/ACC GWTG-HF: mean age ≈ 70–72 years; diabetes ≈ 40–45 %; ischemic etiology ≈ 55–60 %.
→ Jordanian patients are younger with heavier comorbidity burden, especially diabetes and ischemic disease.
3. Symptomatology and Presentation
• Dyspnea: 85.9 %.
• Orthopnea: 39.5 % (over 60 % in acute cases).
• Chest Pain: 32.8 %.
• Paroxysmal Nocturnal Dyspnea (PND): 30.6 %.
• Acute-on-chronic presentations showed greater congestion and symptom severity.
Comparative Context:
• ESC-HF Pilot and AHA/ACC datasets report similar predominant symptoms, but with slightly lower congestion rates at admission due to earlier presentation and stronger outpatient management systems.
4. Key Laboratory Findings
JoHFR Summary (First 24 Hours):
• Elevated BNP/NT-proBNP: ≈ 95 %.
• eGFR < 60 mL/min/1.73 m²: 42.6 %.
• Anemia (Hb < 10 g/dL): 16 %, mean ferritin ≈ 10.8 ng/mL.
• Hyponatremia (<130): 6 %.
• Hyperkalemia (>5): 13 %.
Comparative Context:
• ESC-HF Pilot: median BNP/NT-proBNP elevation ≈ 85–90 %; renal dysfunction ≈ 35 %.
• AHA/ACC GWTG-HF: similar renal dysfunction (≈ 40 %) but lower anemia rates (≈ 10–12 %).
→ Cardiorenal interaction and iron deficiency are more pronounced in JoHFR.
5. Treatment Patterns (Guideline-Directed Medical Therapy – GDMT)
JoHFR Medication Use:
• Beta-blockers: 67 %.
• ACEI: 18 %; ARB: 25 %; ARNI: 10.8 %.
• SGLT2 inhibitors: ≈ 9 %.
• MRAs: 20–28 % (depending on HF type).
Comparative Context:
• ESC-HF Pilot: beta-blockers ≈ 90 %, ACEI/ARB/ARNI ≈ 80 %, MRA ≈ 65 %.
• AHA/ACC GWTG-HF: beta-blockers ≈ 92 %, RAAS inhibitors 80–85 %, SGLT2i ≈ 30–35 %.
→ GDMT utilization in Jordan remains far below global standards, indicating major opportunity for system-level improvement.
6. Device Therapy
• ICD/CRT use: 4 % overall.
• ESC-HF Pilot: ICD ≈ 25–30 %, CRT ≈ 20 %.
• AHA/ACC: ICD/CRT ≈ 35–40 %.
→ Device therapy is markedly underutilized due to financial constraints and access inequity.
7. Outcomes
• In-hospital mortality: 9.6 %.
• Median hospital stay: 6.2 days.
• Mortality correlates strongly with renal dysfunction and delayed therapy initiation.
Comparative Context:
• ESC-HF Pilot: mortality < 5 %, mean LOS ≈ 5 days.
• AHA/ACC: mortality ≈ 2.5–3.5 %, mean LOS ≈ 4.4 days.
→ Jordan’s mortality is two- to three-fold higher, underscoring gaps in acute management and transitional care.
8. Comparison With International Registries
Mean Age
JoHFR – 66 years
ESC-HF Pilot – 67 to 70 years
AHA/ACC – ≈ 70 to 72 years
→ Jordanian patients present 4–6 years earlier on average.
Diabetes Prevalence
JoHFR – 69 %
ESC-HF Pilot – 29–35 %
AHA/ACC – ≈ 40–45 %
→ Diabetes is nearly twice as common in Jordanian patients.
Hypertension Prevalence
JoHFR – 80.7 %
ESC-HF Pilot – variable (lower range)
AHA/ACC – ≈ 75 %
→ Hypertension is highly prevalent in all registries, highest in Jordan.
Ischemic Etiology
JoHFR – 80.6 %
ESC-HF Pilot – 40–50 %
AHA/ACC – ≈ 55–60 %
→ Heart failure in Jordan is predominantly ischemic, reflecting a very high ASCVD burden.
In-Hospital Mortality
JoHFR – 9.6 %
ESC-HF Pilot – < 5 %
AHA/ACC – ≈ 2.5–3.5 %
→ Hospital mortality in Jordan is roughly two- to three-fold higher than in Western registries.
Insight:
Jordanian heart-failure patients are younger, more diabetic, and more often ischemic, with higher in-hospital mortality and lower uptake of guideline-directed therapy than their European and U.S. counterparts — underscoring the need for a national standardized registry and care pathway such as the NHFR-JO initiative.
9. Implications for Clinical Practice
• Strengthen adherence to the four pillars of heart-failure therapy (RAAS inhibitors, beta-blockers, MRAs, SGLT2 inhibitors).
• Improve management of diabetes, hypertension, and ischemic disease.
• Expand access to device therapy and structured post-discharge programs.
• Establish dedicated multidisciplinary Heart Failure Clinics for continuity of care.
10. Implications for Health Policy
• Develop national HF protocols aligned with ESC and AHA guidelines.
• Ensure medication coverage for ARNI and SGLT2 inhibitors.
• Establish sustainable funding for device therapies.
• Launch primary-prevention initiatives addressing hypertension, diabetes, and smoking.
11. Future Directions
• Longitudinal follow-up to assess outcomes and predictors of readmission.
• Evaluation of cost-effectiveness for advanced therapies.
• Implementation of national performance indicators and Heart Failure Centers of Excellence.
• Training programs to enhance clinical adoption of evidence-based practice.
12. Regional and Strategic Impact
• The JoHFR model provides a foundation for Middle Eastern collaboration and comparative data.
• Aligns national metrics with ESC-EORP and AHA/ACC standards.
• Facilitates regional quality improvement and shared learning frameworks.
13. Conclusion
The Jordan Heart Failure Registry (JoHFR) reveals that patients present younger, with a heavier metabolic and ischemic burden, and face significantly higher mortality than Western populations.
These findings support the creation of the National Heart Failure Registry – Jordan (NHFR-JO), designed to unify data collection, standardize care, and bridge the treatment and outcome gaps between Jordan and global benchmarks.
