Global Variations in Heart Failure Etiology, Management, and Outcomes.

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational 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 Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (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 ß-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 Relevance: This 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.

Hospitalized heart failure patients with preserved vs. reduced ejection fraction in Dubai, United Arab Emirates: a prospective study.

AIMS: To compare the baseline characteristics, pharmacological treatment, and in-hospital outcomes across hospitalized heart failure (HF) patients with preserved LVEF (HF-PEF) and those with reduced LVEF (HF-REF). METHOD AND RESULTS: This was a prospective analysis of consecutive patients admitted with decompensated HF at two government hospitals in the United Arab Emirates, from 1 December 2011 to 30 November 2012. Multivariate factors of HF-PEF vs. HF-REF included elevated systolic blood pressure [odds ratio (OR) 1.02; 95% confidence interval (CI) 1.01­1.03], heart rate (OR 0.98; 95% CI 0.97­0.99), age (OR 1.02; 95% CI 1.01­1.04), female sex (OR 2.38; 95% CI 1.41­4.03), angina or myocardial infarction (OR 0.42; 95% CI 0.25­0.71), AF (OR 1.82; 95% CI 1.05­3.15), COPD or asthma (OR 2.80; 95% CI 1.47­5.35), Charlson Comorbidity Index score (OR 0.75; 95% CI 0.64­0.88), and anaemia (OR 2.97; 95% CI 1.64­5.38). In-hospital outcomes were similar between the two groups. However, patients with HF-PEF were less likely to be prescribed HF medication, and used more anticoagulants and fewer antiplatelet medications. CONCLUSION: These results suggest that patients with HF-PEF are older, more often female, and have higher prevalence of respiratory diseases and AF. Compared with developed countries, hospitalized HF patients in the Middle East are 10 years younger and have a higher prevalence of diabetes mellitus, and the majority have HF-REF.