Understanding the Epidemiology of Heart Failure to Improve Management Practices: An Asia-Pacific Perspective.

Heart failure (HF) is a major global healthcare problem with an estimated prevalence of approximately 26 million. In Asia-Pacific regions, HF is associated with a significant socioeconomic burden and high rates of hospital admission. Epidemiological data that could help to improve management approaches to address this burden in Asia-Pacific regions are limited, but suggest patients with HF in the Asia-Pacific are younger and have more severe signs and symptoms of HF than those of Western countries. However, local guidelines are based largely on the European Society of Cardiology and American College of Cardiology Foundation/American Heart Association guidelines, which draw their evidence from studies where Western patients form the major demographic and patients from the Asia-Pacific region are underrepresented. Furthermore, regional differences in treatment practices likely affect patient outcomes. In the following review, we examine epidemiological data from existing regional registries, which indicate that these patients represent a distinct subpopulation of patients with HF. In addition, we highlight that patients with HF are under-treated in the region despite the existence of local guidelines. Finally, we provide suggestions on how data can be enriched throughout the region, which may positively affect local guidelines and improve management practices.

Human leukocyte antigen-G-14-base-pair-insertion/deletion polymorphism and graft survival in kidney transplant recipients.

OBJECTIVES: The human leukocyte antigen-G may have a positive role in graft acceptance in human organ transplant. Several studies have reported an association between the human leukocyte antigen-G-14-base-pair-insertion/deletion polymorphism and risk of developing kidney graft rejection, but the results are inconclusive. We performed a metaanalysis to evaluate this association. MATERIALS AND METHODS: We included 5 case-control studies that evaluated the association between human leukocyte antigen-G-14-base-pair-insertion/deletion polymorphism and risk of developing kidney transplant rejection, including a total 907 patients (rejection, 271 patients; no rejection, 636 patients). RESULTS: There was no significant association between the human leukocyte antigen-G-14-basepair-insertion/deletion polymorphism and risk of developing kidney transplant rejection in the allele contrast, homozygous, heterozygous, recessive, or dominant genetic models for all rejection or acute rejection. In 2 studies, there was a significant association between human leukocyte antigen-G-14-base-pair-insertion/deletion polymorphism and chronic graft rejection in the allele contrast model (+14 vs -14: odds ratio, 0.68; 95% confidence interval: 0.48-0.96; P = .618), heterozygous model (+14/-14 vs -14/-14: odds ratio, 0.44; 95% confidence interval: 0.23-0.83; P = .248), and dominant genetic model ([+14/+14 and +14/-14] vs -14/-14: odds ratio, 0.48; 95% confidence interval: 0.30-0.78; P = .355). CONCLUSIONS: There may be no association between 14-base-pair polymorphisms and risk of developing kidney allograft rejection. Additional studies with larger sample size and better study design are justified.