For a study, researchers designed the CHART-HF study, an observational study of approximately 1,500 patients comparing patients with and without worsening HF events (WHFE) (WHFE being defined as receipt of intravenous diuretics in the inpatient, outpatient, or emergency department setting). These patients had an index outpatient visits in the United States between 2017 and 2019. A single integrated health system and a nationwide panel of cardiologists would provide data for collecting patient-level information on clinical features, clinical outcomes, and therapy. In addition, the reasoning for treatment decisions reported by clinicians and the aspects emphasized during the selection and optimization of medicines in real-world practice were acquired. To characterize aspects of clinician decision-making that were not documented in the medical record, a panel of cardiologists would review the medical records of patients seen under their care and explicitly note the primary reason for initiating, discontinuing, and titrating medications. They would also note the reason for not making changes to each medication during the outpatient visit. This would allow the panel to characterize elements of clinician decision-making that were not documented in the medical record. The results of CHART-HF had the potential to detail real-world practice patterns in the United States regarding the care of patients with heart failure with reduced ejection fraction (HFrEF) who have or have not had a recent WHFE, to investigate the reasons given by clinicians for the use or non-use of guideline-directed medical therapy, and to classify the magnitude and nature of clinical inertia toward evidence-based medication changes for HFrEF. All of these were possible outcomes.

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