National Heart Failure Registry (NHFR-JO) – Framework and Rules
Jordan Cardiac Society (JCS)
National Heart Failure Registry (NHFR-JO) – Framework and Rules
(Issued by the JCS Heart Failure Registry Committee, 2025)
Purpose
The NHFR-JO provides a unified national database for all heart-failure cases in Jordan.
It collects standardized data from hospitals nationwide to improve outcomes, benchmark performance, and guide health-policy decisions.
The registry is aligned with AHA GWTG-HF (2024) and ESC EORP HF-III (2023) datasets, building upon insights from the Jordan Heart Failure Registry (JoHFR 2025).
A. Governance
• Lead Organization: Jordanian Cardiac Society (JCS).
• Scientific Oversight: JCS Heart Failure Committee with representatives from university, public, and private hospitals.
• Participation: mandatory for all centers treating HF patients.
• Data Integration: electronic submission via HL7/FHIR interface or standardized online forms. HL7/FHIR is the internationally approved system for exchanging medical data between hospitals.
It is used in the NHFR-JO according to the official standards of AHA, ESC, and ACC, ensuring secure and standardized data sharing across all centers.
electronic submission via HL7/FHIR interface or standardized online forms.
B. Data Entry Requirements
Each case must be entered at:
1. Admission
2. Discharge
3. 7-day follow-up
4. 30-day readmission (if applicable)
5. 12-month outcome
C. Core Data Fields
1. Patient Identification: means recording the patient’s basic hospital details — a unique registry number, the hospital name, admission number, and the dates of admission and discharge.
2. Demographics: age, sex, nationality/residency, smoking, weight, BMI.
3. Clinical Classification: HF type (chronic / acute-on-chronic / de novo); LVEF % (HFrEF ≤ 40 / HFmrEF 41–49 / HFpEF ≥ 50); etiology (ischemic / hypertensive / valvular / dilated / other).
4. Comorbidities: HTN, diabetes, CAD, CKD, COPD, stroke, AF, obesity, anemia, others.
5. Presentation & Vitals: dyspnea, orthopnea, PND, chest pain, SBP/DBP, HR, SpO₂, NYHA class.
6. Minimum required labs within the first 24 hours:
BNP or NT-proBNP, creatinine/eGFR, sodium, potassium, and hemoglobin -these core tests are mandatory in both AHA and ESC heart-failure registries to assess cardiac stress, kidney function, electrolytes, and anemia.
Ferritin is recommended to detect iron deficiency when available.
7. Echocardiography (for HF registries):
• LVEF — Mandatory.
• LV size/type (e.g., LVEDD), systolic/diastolic dysfunction classification, MR grade, E/e′, and PASP — Recommended optional (as endorsed when available in both AHA 2024 and ESC 2023 updates).
8. Medications (GDMT):
• ARNI / ACEI / ARB
• β-blocker
• MRA
• SGLT2 inhibitor
• Loop diuretic (dose & route)
For each: record : Start / Continue / Contraindicated and note reason if not prescribed (renal function, low BP, cost, etc.).
9. Device Therapy: ICD/CRT (Y/N); if “No”, record reason (cost, access, or ineligibility).
10. Discharge Plan:
Check and confirm all medications, educate the patient, arrange follow-up within 14 days, and refer to a heart-failure clinic.
11. Outcomes: in-hospital mortality, length of stay, 30-day readmission, 1-year survival.
D. Data Quality
• Automatic validation of numeric ranges and mandatory fields.
• Data completeness target ≥ 95%.
• Monthly random audits and quarterly benchmarking across centers.
• No record can be closed without an explanation for missing GDMT or device therapy.
In other words, no case can be completed unless the reason for missing heart-failure medication or device therapy is clearly documented.
E. Reporting & Recognition
Following AHA’s quality model:
• Bronze Tier: continuous reporting ≥ 90 days.
• Silver Tier:
Data reported for 12 months with proper use of HF medications and 7-day follow-up after discharge.
• Gold Tier: 24 months of sustained excellence and advanced indicators (iron therapy, device use, outcomes).
F. Key Performance Indicators (KPIs)
• GDMT prescription at discharge:
β-blocker ≥ 90%; RAASi/ARNI ≥ 80%; MRA ≥ 65%; SGLT2i ≥ 50% (aim ≥ 80%).
• Early follow-up ≤ 7 days ≥ 90%.
• Iron assessment/treatment ≥ 80%.
• Documented ICD/CRT referral ≥ 95%.
• In-hospital mortality < 5%; 30-day readmission < 20%.
• Data completeness ≥ 95%.
G. Privacy & Security:
Patient data are protected and used only according to privacy regulations in Jordan.
H. Education & Support:
An authorized national body provides user guides, regular training, and technical support, and reviews reports for accuracy and publication.
I. Continuous Improvement
• Live dashboards display performance for each center.
• Underperforming sites receive corrective guidance.
• Annual national summary shared with the Ministry of Health and participating hospitals.
• Registry outcomes guide resource allocation, training priorities, and future protocol updates.
References
1. AHA – Get With The Guidelines–Heart Failure (GWTG-HF) Update 2024.
2. ESC – EORP Heart Failure III Dataset 2023.
3. ACC – National Cardiovascular Data Registry (NCDR) and ICOE Framework 2024.
4. JoHFR – Jordan Heart Failure Registry Final Report 2025.
5. Jordan Cardiac Society – National Heart Failure Task Force 2025.