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8 p., Background Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions. Here, in the International Congestive Heart Failure (INTERCHF) study, we aimed to measure mortality at 1 year in patients with heart failure in Africa, China, India, the Middle East, southeast Asia and South America; we also explored demographic, clinical, and socioeconomic variables associated with mortality. Methods We enrolled consecutive patients with heart failure (3695 [66%] clinic outpatients, 2105 [34%] hospital in patients) from 108 centres in six geographical regions. We recorded baseline demographic and clinical characteristics and followed up patients at 6 months and 1 year from enrolment to record symptoms, medications, and outcomes. Time to death was studied with Cox proportional hazards models adjusted for demographic and clinical variables, medications, socioeconomic variables, and region. We used the explained risk statistic to calculate the relative contribution of each level of adjustment to the risk of death. Findings We enrolled 5823 patients within 1 year (with 98% follow-up). Overall mortality was 16·5%: highest in Africa (34%) and India (23%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the Middle East (9%). Regional differences persisted after multivariable adjustment. Independent predictors of mortality included cardiac variables (New York Heart Association Functional Class III or IV, previous admission for heart failure, and valve disease) and non-cardiac variables (body-mass index, chronic kidney disease, and chronic obstructive pulmonary disease). 46% of mortality risk was explained by multivariable modelling with these variables; however, the remainder was unexplained. Interpretation Marked regional differences in mortality in patients with heart failure persisted after multivariable adjustment for cardiac and non-cardiac factors. Therefore, variations in mortality between regions could be the result of health-care infrastructure, quality and access, or environmental and genetic factors. Further studies in large, global cohorts are needed. Funding The study was supported by Novartis.

Haji Abdul Rahman Limbong was a religious scholar and a Malay fighter feared by the British colonialists. British had regarded him as a rebel. He was more known to many as a religious teacher, as well as a successful trader and entrepreneur. The present study investigates Haji Abdul Rahman Limbong’s struggle with a focus on three objectives. Firstly, he defended the rights of the settlers and the people of Terengganu from further being governed by the British power. Secondly, he adopted the approach of religious studies to the people, title defence through the Court ruling, opposing to the colonial power through the spirit of Jihad and defending the politics of the state by means of the legislation. Thirdly, he ennobled the Sultanate institution and gave an undivided support to the state administration. A qualitative approach by analyzing available documentation from Public Record Office, Terengganu, is employed to reveal the aims of this study. It is highlighted that defending the people had been the central cause for Haji Abdul Rahman Limbong’s struggle. DOI: 10.5901/mjss.2015.v6n6s1p281