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Title: Global mortality variations in patients with heart failure : Results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study
Authors: López Jaramillo, Patricio
Dokainish, Hisham
Teo, Koon
Zhu, Jun
Roy, Ambuj
AlHabib, Khalid F.
ElSayed, Ahmed
Palileo Villaneuva, Lia
Karaye, Kamilu
Yusoff, Khalid
Orlandini, Andres
Sliwa, Karen
Mondo, Charles
Lanas, Fernando
Prabhakaran, Dorairaj
Badr, Amr
Elmaghawry, Mohamed
Damasceno, Albertino
Tibazarwa, Kemi
Belley Cote, Emilie
Balasubramanian, Kumar
Islam, Shofiqul
Yacoub, Magdi H.
Huffman, Mark D.
Harkness, Karen
Grinvalds, Alex
McKelvie, Robert
Bangdiwala, Shrikant I.
Yusuf, Salim
On behalf of the INTER-CHF Investigators.
Keywords: Global
Heart failure
Issue Date: 1-Jul-2017
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. Funding The study was supported by Novartis.
Description: 8 p.
ISSN: 2214-109X
Appears in Collections:DCABA. Artículos de Investigación

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