Recruitment strategies in registry-based observational research: A single center experience in the United States from the HeartShare Study

Background: Recruiting a representative sample of US adults is challenging, and strategies to improve recruitment have not been well-evaluated.This study examined differences in consent rates across three recruitment approaches for the HeartShare registry at a single academic center. Methods:The HeartShare registry is a multicenter observational cohort enrolling adults age 30 years with or without heart failure.We included participants contacted at a single academic center between 8/1/2023-8/1/2024 and compared consent rates across three recruitment methods:(1) telephone; (2) electronic health record (EHR) messaging; or (3) in-person.Secondary analyses evaluated differences in consent rates within recruitment strategies by sociodemographic factors.Results: Among 9712 patients contacted (mean [standard deviation] age 72.0 [13.1] years, 46.5% female), 4.2% consented.Of the 1,439 patients contacted by telephone, 175 (12.1%) consented.Of the 8,080 patients contacted through EHR messaging, 144 (1.8%) consented.Of the 193 contacted in-person, 79 (41%) consented.Compared to phone recruitment, EHR had the lowest consent rate (adjusted odds ratio [95% confidence interval]: 0.13 [0.10-0.17])while inperson had the highest consent rate (6.49[4.42-9.53]).In-person recruitment showed no significant differences in consent rates between Black and White participants (0.69 [0.30-1.56]).Among those approached via EHR or phone, Black individuals had significantly lower odds of consenting compared to White individuals (EHR: 0.31 [0.12-0.67];Phone: 0.36 [0.18-0.67]). Conclusions:In-person recruitment achieved the highest consent rates across groups in this observational registry-based cohort.Although less time-intensive, automated EHR recruitment was less effective in engaging underrepresented groups.