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

Dokainish, Hisham and Teo, Koon and Zhu, Jun and Roy, Ambuj and F AlHabib, Khalid and ElSayed, Ahmed and Palileo-Villaneuva, Lia and Lopez-Jaramillo, Patricio and Karaye, Kamilu and Yusoff, Khalid and Orlandini, Andres and Sliwa, Karen and Mondo, Charles and Lanas, Fernando and Prabhakaran, Dorairaj and Badr, Amr and Elmaghawry, Mohamed and Damasceno, Albertino and Tibazarwa, Kemi and Belley-Cote, Emilie and Balasubramanian,, Kumar and Islam, Shofiqul and H Yacoub, Magdi and D Huffman, Mark and Harkness, Karen and Grinvalds, Alex and McKelvie, Robert and I Bangdiwala, Shrikant and Yusuf, Salim (2017) Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. The Lancet Global Health, 5 (7). e665-e672. ISSN 0140-6736

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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 (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.

Item Type: Article
Subjects: WA Public Health
Divisions: Faculty of Medicin
Depositing User: Touba Derakhshande
Date Deposited: 04 Sep 2017 04:51
Last Modified: 04 Sep 2017 04:51
URI: http://eprints.bpums.ac.ir/id/eprint/5785

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