Global Registries and Surveys Programme-Heart Failure (GRASP-HF): Rationale, study design and research implications

Heart failure (HF) is characterized by increasing prevalence, high morbidity and mortality, poor quality of life, and substantial healthcare costs. Despite advancements in pharmacologic and device-based therapies, translating evidence from randomized controlled trials into clinical practice remains suboptimal. The Global Registries and Surveys Programme–Heart Failure (GRASP-HF) is a pan-European, snapshot, observational study, aiming at assessing the real-world implementation of evidence-based HF management. GRASP-HF captures both acute and chronic HF presentations to assess the adherence to the 2021 and 2023 European Society of Cardiology (ESC) HF Guidelines. It also serves as a platform for the accreditation of HF centres for the Improving Care through Accreditation and Recognition in Heart Failure (ICARe-HF) programme. This manuscript outlines the rationale, methodology, and design of GRASP-HF. Unlike previous registries, GRASP-HF ensures that all patients are consecutively enrolled over a pre-defined 2-month period, minimizing selection bias. GRASP-HF offers a real-time perspective on diagnostic strategies, use of guideline-recommended medical therapy and implementation of quality-of-care indicators. In addition, GRASP-HF addresses less explored domains by other registries, such as frailty, rare aetiologies (e.g. amyloidosis, genetic cardiomyopathies, Takotsubo syndrome), as well as non-fatal events during hospitalization and follow-up. GRASP-HF is also designed to inform ESC educational strategies and to benchmark progresses in HF care across European and non-European centres. In conjunction with ICARe-HF, annual repetition of GRASP-HF aims to facilitate continuous feedback between evidence, practice, and quality improvement. GRASP-HF will assist National Cardiac Societies in shaping national and institutional policies and will contribute with data-driven insights to future guideline development.