Global Variations in Heart Failure Etiology, Management, and Outcomes
Author:
, Rasmussen Mariela1, Prado Aldo1, Hominal Miguel A.1, Zaidman Cesar J.1, Cursack Guillermo1, MacKinnon Ignacio1, Zapata Gerardo1, Rojas David G.1, Duran Ruben G.1, Vilamajo Oscar G.1, Dutra Oscar P.1, Oliveira Lívia1, Pavanello Ricardo1, Minelli César1, Sousa Antonio1, Maia Lilia N.1, Hernandes Mauro E.1, Oliveira Múcio1, De Souza Weimar K. S. B.1, Nobre Fernando1, Clausell Nadine1, Abib Eduardo1, Bazan Silmeia Z.1, Reis Gilmar1, Clovis Nkoke1, Tantchou Cabral1, Abah Joseph P.1, Kouam Charles K.1, Tamdja Anastase D.1, Manon Guillaume E.1, Abang Serah M.1, Feuzeu Stachys A. N.1, Ban'Haka Herve M.1, Nganou-Gnindjio Chris N.1, Colette Sih1, Nyanga Albert1, Fomekong Tchinda G.1, Ndjebet Jules1, Ngongang Florent A. D.1, Anderson Kim1, Lepage Serge1, Tournoux Francois1, Racine Normand1, Smith Stuart1, McKelvie Robert1, Moe Gordon1, Zieroth Shelley1, Toma Mustafa1, Sia Ying T.1, Heckman George1, Ross Heather1, Ezekowitz Justin1, Senechal Mario1, Swiggum Elizabeth1, Vega Mario1, Jano Gabriel1, Bobadilla Braulio1, Tan Huiqiong1, Gou Jian W.1, Jin Wei1, Jiang Heng1, Ai Fen1, Zhou Wenxiu1, Luo Hai Y.1, Wei Fang1, Jia Zhisheng1, Peng Jie1, Wang Xiuhong1, Bai Xioajuan1, Xu Jing1, Liang Xue W.1, Chen XiaoPing1, Wang Tianxun1, Zheng Tinlin1, Qin Shaoming1, Liang Tao1, Tan Gange1, Gao Xia1, Chen Yunguo1, Wu Jijin1, Garcia Angel1, Murillo Nelson1, Ceron Juan A.1, De Salazar Dora I. M.1, Sandoval Jorge1, Buitrago Andres1, Eljach Julian E. V.1, Mendoza Jose L. A.1, Moreno Gustavo S.1, Lozada Henry G.1, Carreno Erika M. M.1, Quiroz Franklin1, Cadena Bonfanti Alberto1, Buelvas Jannes1, Dada Fredy A. T.1, Sogaard Peter1, Pedersen Maria1, Gislason Gunnar1, Nielsen Gitte1, Wiggers Henrik1, Jaramillo Milton S.1, Anzules Nicholas1, Duarte Yan C.1, Long Freddy P. C.1, Zuelta Iván1, Velez Mayra S.1, Lopez José1, Trujillo Freddy1, Carrasco Santiago1, Gulec Sadi1, Cavusoglu Yuksel1, Acar Deniz R.1, Yilmaz Mehmet B.1, Celik Ahmet1, Gosse Philippe1, Kenizou David1, Delarche Nicolas1, Boulestreav Romain1, Goussot Samuel1, Hamou Kamel H.1, Jourda Francois1, Guillot Jean Paul1, Tartiere Jean Michel1, Schellong Sebastian1, Mahrholdt Heiko1, Jungmair Wolfgang1, Kadel Christoph1, Wolf Alexander1, Bruder Oliver1, Bott Michael C1, Nagele Herbert1, Hertting Klaus1, Ito Wulf1, Hintze Rene1, Stahl Fabian1, Maier Sebastian1, Weiss Christian1, Stoerk Thomas1, Drexler Michael1, Hagenow Andreas1, Asotra Sanjeev1, Chaudley Gaurav1, Gupta Rajeev1, Mohan Bishav1, Jathappa Narendra1, Varghese Kiron1, Abdullakutty Jabir1, Negi Parkash1, Karna Sunil1, Chandra Sharad1, Russo Giulia1, Cosmi Franco1, D'Orazio Simona1, Gulizia Michele1, Moccetti Tiziano1, Scopigni Francesca1, Marcassa Claudio1, Frisinghelli Anna1, Villani Giovanni Q1, Venturi Flavio1, Piccinni Giancarlo1, Piepoli Massimo1, Nalwa Wafula1, Mbugua Evelyn1, Barasa Felix1, Castro-Montes Eliodoro1, Lopez Jose A. C.1, Bhatta Yadav1, Sharma Deewakar1, Ansa Victor1, Ogah Okechukwu1, Saidu Hadiza1, Kayani Azhar M.1, Evangelista Lauren K.1, Tirador Louie1, Cruz Josefina1, Morales Dante1, Sulit Dennis1, Bednarski Janusz1, Czerski Tomasz1, Skorski Marcin1, Cymerman Krzysztof1, Korol Marek1, Miklaszewicz Beata1, Piepiorka Marek1, Wujkowski Marek1, Mirek-Bryniarska Ewa1, Owsiak Michal1, Gniot Jacek1, Stasiwski Arkadiusz1, Solkiewicz Monika1, Sudnik Wanda1, Chmielinski Arkadiusz1, Andrade Aurora1, Moreira Ilidio1, Isakova Svetlana1, Ivan Shvedov1, Kovalkova Natalia1, Panov Dmitry1, Salbieva Anzhela1, Sergey Zabashta1, Yufereva Yulia1, Yusubova Anara1, Poponina Tatiana1, Gafarov Valery1, Osipova Irina1, Pozdnyakov Yury1, Sizova Zhanna1, Habeeb Waleed1, Kassim Yasser1, Monem Salwa1, Zeyad Mohamed1, Alasmari Sami1, Alghalayini Kamal1, Kinsara Abdulhalim1, Ullah Jan Ubaid1, Lawand Samih1, Mphahlele Makgotsane J.1, Moeketsi Khulile1, Ntsekhe Mpiko1, Ratsela Andrew1, Thomas Baby M.1, Caballero Eduardo B.1, De La Espriella Rafael1, Garrido Bravo Iris1, Minan Gema1, Paniagua Martin Maria J.1, Perez Francisco1, Roses Josep L.1, Santiago Evelyn1, Goloskokova Valentina1, Thulin Jorgen1, Thorvaldsen Tonje1, Lindholm Carl-Johan1, Floderer Nagy Z1, Lönnberg Ingemar1, Kanenda Said1, Duma Neema1, Meda John R.1, Chillo Pilly1, Vogt Rainer1, Kalokola Fredrick1, Kataraihya Johannes1, Mwakalukwa Benson1, Kisenge Peter1, Cetin Hande E. O.1, Lugero Charles1, Voronkov Leonid1, Fedorov Sergiy1, Andriyevska Svitlana1, Vereschuk Larysa1, Zalizna Yulia1, Jhund Pardeep1, Barton John1, Moriarty Andrew1, Donnelly Patrick1, Murphy Andrew1, Edwards Tim1, Arden Christopher1, Fuat Ahmet1, Witherow Fraser1, Mcadam Brendan1, Arimie Raluca1, Adler Frederic1, Maurice Kristen1, Meier Mark A.1, Mehta Rajendra1, Kitchen Timothy1, Malhotra Vinay1, Whellan David1, Piña Illeana1, Murthy Sandhya1, Kostis John1, Gulati Martha1, Gopalan Radha1, Gaggin Hanna1, Airhart Sophia1, Juneman Elizabeth1, Sweitzer Nancy1, Thew Stephen1, Joseph Philip2, Roy Ambuj3, Lonn Eva2, Störk Stefan4, Floras John5, Mielniczuk Lisa6, Rouleau Jean-Lucien7, Zhu Jun8, Dzudie Anastase9101112, Balasubramanian Kumar2, Karaye Kamilu13, AlHabib Khalid F.14, Gómez-Mesa Juan Esteban15, Branch Kelley R.16, Makubi Abel17, Budaj Andrzej18, Avezum Alvaro19, Wittlinger Thomas20, Ertl Georg4, Mondo Charles21, Pogosova Nana22, Maggioni Aldo Pietro23, Orlandini Andres24, Parkhomenko Alexander25, ElSayed Ahmed26, López-Jaramillo Patricio27, Grinvalds Alex2, Temizhan Ahmet28, Hage Camilla2930, Lund Lars H.2930, Kazmi Khawar31, Lanas Fernando32, Sharma Sanjib Kumar33, Fox Keith34, McMurray John J.V.35, Leong Darryl2, Dokainish Hisham2, Khetan Aditya2, Yonga Gerald36, Kragholm Kristian37, Wagdy Shaker Kerolos38, Mwita Julius Chacha39, Al-Mulla Arif Abdullatif40, Alla François41, Damasceno Albertino42, Silva-Cardoso José4344, Dans Antonio L.45, Sliwa Karen10, O’Donnell Martin46, Bazargani Nooshin47, Bayés-Genís Antoni48, McCready Tara2, Probstfield Jeffrey16, Yusuf Salim2
Affiliation:
1. G-CHF Investigators 2. Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada 3. Department of Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India 4. Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Department Internal Medicine, University Hospital, Würzburg, Germany 5. Mount Sinai Hospital, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada 6. University of Ottawa, University of Ottawa Heart Institute, Ottawa, Ontario, Canada 7. Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada 8. FuWai Hospital, Beijing, China 9. Department of Global Health and Population, Lown Scholars Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts 10. Cape Heart Institute, University of Cape Town, Cape Town, South Africa 11. Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon 12. Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa 13. Bayero University and Aminu Kano Teaching Hospital, Department of Medicine, Kano, Nigeria 14. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia 15. Fundación Valle Del Lili, Department of Cardiology and Universidad Icesi, Cali, Colombia 16. University of Washington, Cardiology, Seattle 17. Community Development, Gender, Elderly, and Children, Ministry of Health, Dodoma, Tanzania 18. Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland 19. International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil 20. Department of Cardiology, Asklepios Hospital Goslar, Goslar, Germany 21. Kiruddu National Referral Hospital, Kampala, Uganda 22. Medical Research Center of Cardiology named after E.I. Chazov, Moscow, Russia 23. ANMCO Research Center, Heart Care Foundation, Florence, Italy 24. Estudios Clínicos Latino America Collaborative Group, Rosario, Argentina 25. Emergency Cardiology Department, National Scientific Centre, Strazhesko Institute of Cardiology, Kiev, Ukraine 26. Alzaeim Alazhari University, Khartoum, Sudan 27. Universidad de Santander (UDES), Bucaramanga, Santander, Colombia 28. Clinic of Cardiology, University of Health Science, Ankara City Hospital, Ankara, Türkiye 29. Karolinska Institutet, Department of Medicine, Cardiology Unit, Stockholm, Sweden 30. Karolinska University Hospital, Heart and Vascular Theme, Heart Failure Section, Stockholm, Sweden 31. Department of Cardiology, Aga Khan University, Karachi, Pakistan 32. Universidad de La Frontera, Temuco, Chile 33. B P Koirala Institute of Health Sciences, Dharan, Nepal 34. Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom 35. British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom 36. University of Nairobi, Department of Clinical Medicine and Therapeutics, Nairobi, Nairobi City County, Kenya 37. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark 38. Aswan Heart Center, Magdi Yacoub Foundation, Department of Cardiology, Aswan, Egypt 39. University of Botswana, Internal Medicine, Gaborone, Botswana 40. Division of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates 41. Bordeaux Population Health Research Center, Université de Bordeaux, Bordeaux, France 42. Eduardo Mondlane University, Faculty of Medicine, Maputo, Mozambique 43. Faculty of Medicine, University of Porto, Porto, Portugal 44. São João University Hospital Centre, Porto, Portugal 45. University of the Philippines, Medicine, Quezon City, National Capital Region, Philippines 46. College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland 47. Dubai Hospital, Dubai, United Arab Emirates 48. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, CIBERCV, Spain
Abstract
ImportanceMost epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries.ObjectiveTo examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development.Design, Setting, and ParticipantsMultinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years.Main Outcomes and MeasuresHF cause, HF medication use, hospitalization, and death.ResultsMean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies.Conclusions and RelevanceThis study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.
Publisher
American Medical Association (AMA)
Cited by
40 articles.
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