Kristensen, S. L. L. et al. (2015) International geographic variation in event rates in trials of heart failure with preserved and reduced ejection fraction. Circulation, 131(1), pp. 43-53. (doi: 10.1161/CIRCULATIONAHA.114.012284)
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Publisher's URL: http://dx.doi.org/10.1161/CIRCULATIONAHA.114.012284
Abstract
<b>Background</b>—International geographic differences in outcomes may exist for clinical trials of heart failure and reduced ejection fraction (HF-REF), but there are few data for those with preserved ejection fraction (HF-PEF).<p></p> <b>Methods and Results</b>—We analyzed outcomes by international geographic region in the Irbesartan in Heart Failure with Preserved systolic function trial (I-Preserve), the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved trial, the CHARM-Alternative and CHARM-Added HF-REF trials, and the Controlled Rosuvastatin Multinational Trial in HF-REF (CORONA). Crude rates of heart failure hospitalization varied by geographic region, and more so for HF-PEF than for HF-REF. Rates in patients with HF-PEF were highest in the United States/Canada (HF hospitalization rate 7.6 per 100 patient-years in I-Preserve; 8.8 in CHARM-Preserved), intermediate in Western Europe (4.8/100 and 4.7/100), and lowest in Eastern Europe/Russia (3.3/100 and 2.8/100). The difference between the United States/Canada versus Eastern Europe/Russia persisted after adjustment for key prognostic variables: adjusted hazard ratios 1.34 (95% confidence interval, 1.01-1.74; P=0.04) in I-Preserve and 1.85 (95% confidence interval, 1.17-2.91; P=0.01) in CHARM-Preserved. In HF-REF, rates of HF hospitalization were slightly lower in Western Europe compared with other regions. For both HF-REF and HF-PEF, there were few regional differences in rates of all-cause or cardiovascular mortality.<p></p> <b>Conclusions</b>—The differences in event rates observed suggest there is international geographic variation in 1 or more of the definition and diagnosis of HF-PEF, the risk profile of patients enrolled, and the threshold for hospitalization, which has implications for the conduct of future global trials.<p></p>
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Kristensen, Mr Soren Lund and Jhund, Professor Pardeep and McMurray, Professor John |
Authors: | Kristensen, S. L. L., Køber, L., Jhund, P. S., Solomon, S. D., Kjekshus, J., McKelvie, R. S., Zile, M. R., Granger, C. B., Wikstrand, J., Komajda, M., Carson, P. E., Pfeffer, M. A., Swedberg, K., Wedel, H., Yusuf, S., and McMurray, J. J. V. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | Circulation |
Publisher: | American Heart Association |
ISSN: | 0009-7322 |
ISSN (Online): | 1524-4539 |
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