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1. Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study

Author

Dr Hisham Dokainish, MD, Koon Teo, PhD, Jun Zhu, MD, Ambuj Roy, MD, Khalid F AlHabib, MBBS, Ahmed ElSayed, MD, Lia Palileo-Villaneuva, MD, Patricio Lopez-Jaramillo, PhD, Kamilu Karaye, MD, Khalid Yusoff, MD, Andres Orlandini, MD, Karen Sliwa, PhD, Charles Mondo, MD, Fernando Lanas, MD, Dorairaj Prabhakaran, MD, Amr Badr, MD, Mohamed Elmaghawry, PhD, Albertino Damasceno, MD, Kemi Tibazarwa, MD, Emilie Belley-Cote, MD, Kumar Balasubramanian, MSc, Shofiqul Islam, MSc, Magdi H Yacoub, MD, Mark D Huffman, MD, Karen Harkness, PhD, Alex Grinvalds, BSc, Robert McKelvie, PhD, Shrikant I Bangdiwala, PhD, Salim Yusuf, DPhil, R. Campos, C. Chacón, G. Cursack, F. Diez, C. Escobar, C. Garcia, O. Gomez Vilamajo, M. Hominal, A. Ingaramo, G. Kucharczuk, M. Pelliza, A. Rojas, A. Villani, G. Zapata, P. Bourke, F. Lanas, L. Nahuelpan, C. Olivares, R. Riquelme, F. Ai, X. Bai, X. Chen, Y. Chen, M. Gao, C. Ge, Y. He, W. Huang, H. Jiang, T. Liang, X. Liang, Y. Liao, S. Liu, Y. Luo, L. Lu, S. Qin, G. Tan, H. Tan, T. Wang, X. Wang, F. Wei, F. Xiao, B. Zhang, T. Zheng, J.L. Accini Mendoza, M. Blanquicett Anaya, E. Gomez, D.I. Molina de Salazar, F. Quiroz, M.J. Rodríguez, M. Suarez Sotomayor, A. Torres Navas, M. Bravo León, L.A. Falconi Montalvo, M. Lopez Jaramillo, E. Peñaherrera Patiño, C. Perugachi, F. Trujillo Cruz, M. Elmaghawry, K. Wagdy, A.K. Bhardwaj, V. Chaturvedi, G. Krishna Gokhale, R. Gupta, R. Honnutagi, P. Joshi, S. Ladhani, P.C. Negi, A. Roy, N. Reddy, A. Abdullah, M.R. Abu Hassan, M. Balasinga, S. Kasim, W.Y. Tan, K. Yusoff, A. Damasceno, R. Banze, E. Calua, C. Novela, J. Chemane, A.A. Akintunde, V. Ansa, H. Gbadamosi, K.M. Karaye, A. Mbakwem, S. Mohammed, E. Nwafor, D. Ojji, T. Olunuga, B. Onwubere H. Sa'idu, E. Umuerri, J. Alcaraz, L. Palileo-Villanueva, E. Palomares, M. Roxas Timonera, A. Badr, S. Alghamdi, K. Alhabib, A. Almasood, S. Alsaif, A. Elasfar, A. Ghabashi, L. Mimish, F. Bester, D. Kelbe, E. Klug, K. Sliwa, K. Tibarzawa, O.E. Abdalla, M.E. Dimitri, H. Mustafa, O. Osman, A. Saad, and C. Mondo

Subjects
Public aspects of medicine, RA1-1270
Abstract

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 (INTER-CHF) 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.

Published
2017
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2. Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study

Author

T. Zheng, E. Calua, E. Nwafor, L.A. Falconi Montalvo, L. Nahuelpan, A. Villani, F. Wei, H. Tan, M. Gao, H. Mustafa, Prakash Chand Negi, Dike B. Ojji, Jun Zhu, X. Liang, Layth Mimish, F. Xiao, G. Cursack, X. Bai, M. Blanquicett Anaya, T. Wang, Osman Osman, Abdullah Ghabashi, VO Ansa, Taiwo Olunuga, Koon K. Teo, K. Tibarzawa, A. Ingaramo, W.Y. Tan, R. Honnutagi, J. Alcaraz, Andres Orlandini, Karen Sliwa, Célia Novela, Magdi H. Yacoub, A. Torres Navas, F. Trujillo Cruz, A. Badr, Sulaiman Ladhani, G. Krishna Gokhale, P. Bourke, Kamilu M. Karaye, E. Peñaherrera Patiño, Amam Mbakwem, Karen Harkness, C. Escobar, C. Olivares, N. Reddy, Shafiu Mohammed, Salim Yusuf, F. Quiroz, G. Tan, S. Liu, Abdelfatah Elasfar, T. Liang, X. Wang, Ambuj Roy, B. Zhang, Hisham Dokainish, B. Onwubere H. Sa'idu, M.R. Abu Hassan, F. Bester, M. Bravo León, M. Balasinga, F Lanas, F. Ai, Saleh AlGhamdi, M. Lopez Jaramillo, Charles Mondo, M. Roxas Timonera, D. Kelbe, O.E. Abdalla, Amr Badr, Vivek Chaturvedi, R. Banze, S. Qin, R Gupta, K.M. Karaye, A.K. Bhardwaj, E. Klug, Adeseye A Akintunde, Khalid F. AlHabib, M. Hominal, Y. Liao, Ahmed Saad, M.J. Rodríguez, M. Suarez Sotomayor, Fernando Lanas, H. Jiang, C. Garcia, L. Lu, X. Chen, G. Kucharczuk, Shrikant I. Bangdiwala, J.L. Accini Mendoza, K. Sliwa, Y. He, Lia Palileo-Villaneuva, H. Gbadamosi, Mark D. Huffman, Emilie P. Belley-Côté, C. Chacón, Shukri AlSaif, F. Diez, Patricio Lopez-Jaramillo, Akmaliza Abdullah, W. Huang, Ali Almasood, Kerolos Wagdy, C. Perugachi, Robert S. McKelvie, Kamaruzzaman bin Yusoff, E M Umuerri, A. Damasceno, C. Ge, Sazzli Kasim, Dorairaj Prabhakaran, M. Elmaghawry, Elieth Gomez, E. Palomares, Lia M. Palileo-Villanueva, Y. Chen, C. Mondo, G. Zapata, Alex Grinvalds, A. Rojas, M. Pelliza, D.I. Molina de Salazar, O. Gomez Vilamajo, Prashant P. Joshi, R. Riquelme, Mohamed ElMaghawry, Kumar Balasubramanian, A. Roy, Albertino Damasceno, M.E. Dimitri, J. Chemane, Shofiqul Islam, KF AlHabib, Ahmed Elsayed, Y. Luo, Kemi Tibazarwa, Khalid Yusoff, and R. Campos

Subjects
COUNTRIES, AFRICA, Male, ASCEND-HF, 030204 cardiovascular system & hematology, Global Health, 03 medical and health sciences, 0302 clinical medicine, CLINICAL CHARACTERISTICS, Risk Factors, ECONOMIC BURDEN, MANAGEMENT, medicine, Global health, Humans, In patient, Prospective Studies, 030212 general & internal medicine, Mortality, Prospective cohort study, Socioeconomic status, Public, Environmental & Occupational Health, Aged, Heart Failure, OUTCOMES, Science & Technology, Models, Statistical, Proportional hazards model, business.industry, lcsh:Public aspects of medicine, Global, lcsh:RA1-1270, General Medicine, Middle Aged, medicine.disease, INTER-CHF Investigators, Hospitalization, INTER-CHF, Socioeconomic Factors, REGISTRY, Heart failure, TRIAL, Female, Risk of death, business, Life Sciences & Biomedicine, REDUCED EJECTION FRACTION, Kidney disease, Demography
Abstract

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.

Published
2017

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