Hisham Dokainish1, Koon Teo2, Jun Zhu3, Ambuj Roy4, Khalid F AlHabib5, Ahmed ElSayed6, Lia Palileo-Villaneuva7, Patricio Lopez-Jaramillo8, Kamilu Karaye9, Khalid Yusoff10, Andres Orlandini11, Karen Sliwa12, Charles Mondo13, Fernando Lanas14, Dorairaj Prabhakaran15, Amr Badr16, Mohamed Elmaghawry17, Albertino Damasceno18, Kemi Tibazarwa19, Emilie Belley-Cote2, Kumar Balasubramanian2, Shofiqul Islam2, Magdi H Yacoub20, Mark D Huffman21, Karen Harkness2, Alex Grinvalds2, Robert McKelvie2, Shrikant I Bangdiwala2, Salim Yusuf2. 1. Population Health Research Institute, McMaster University, Hamilton, Canada. Electronic address: hisham.dokainish@phri.ca. 2. Population Health Research Institute, McMaster University, Hamilton, Canada. 3. Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 4. All India Institute of Medical Science, New Delhi, India. 5. King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia. 6. AlShaab Teaching Hospital, Khartoum, Sudan. 7. University of the Philippines, Manila, Philippines. 8. Fundación Oftalmológica de Santander, (FOSCAL) and Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia. 9. Aminu Kano Teaching Hospital and Bayero University, Kano, Nigeria. 10. UCSI University and UiTM Selayang, Selangor University, Cheras, Malaysia. 11. ECLA Foundation, Instituto Cardiovascular de Rosario, Argentina. 12. Hatter Institute for Cardiovascular Research in Africa, SAMRC, Faculty of Health Sciences, University of Cape Town, South Africa. 13. Mulago National Referral Hospital, Kampala, Uganda. 14. Universidad de La Frontera, Temuco, Chile. 15. Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India. 16. Hamad Medical Center, Doha, Qatar. 17. Aswan Heart Centre, Aswan, Egypt. 18. Eduardo Mondlane University, Maputo, Mozambique. 19. Department of Cardiovascular Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania. 20. Hamad Medical Center, Doha, Qatar; Aswan Heart Centre, Aswan, Egypt. 21. Northwestern University Feinberg School of Medicine, Chicago, USA.
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.
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.
Authors: Santanu Guha; S Harikrishnan; Saumitra Ray; Rishi Sethi; S Ramakrishnan; Suvro Banerjee; V K Bahl; K C Goswami; Amal Kumar Banerjee; S Shanmugasundaram; P G Kerkar; Sandeep Seth; Rakesh Yadav; Aditya Kapoor; Ajaykumar U Mahajan; P P Mohanan; Sundeep Mishra; P K Deb; C Narasimhan; A K Pancholia; Ajay Sinha; Akshyaya Pradhan; R Alagesan; Ambuj Roy; Amit Vora; Anita Saxena; Arup Dasbiswas; B C Srinivas; B P Chattopadhyay; B P Singh; J Balachandar; K R Balakrishnan; Brian Pinto; C N Manjunath; Charan P Lanjewar; Dharmendra Jain; Dipak Sarma; G Justin Paul; Geevar A Zachariah; H K Chopra; I B Vijayalakshmi; J A Tharakan; J J Dalal; J P S Sawhney; Jayanta Saha; Johann Christopher; K K Talwar; K Sarat Chandra; K Venugopal; Kajal Ganguly; M S Hiremath; Milind Hot; Mrinal Kanti Das; Neil Bardolui; Niteen V Deshpande; O P Yadava; Prashant Bhardwaj; Pravesh Vishwakarma; Rajeeve Kumar Rajput; Rakesh Gupta; S Somasundaram; S N Routray; S S Iyengar; G Sanjay; Satyendra Tewari; Sengottuvelu G; Soumitra Kumar; Soura Mookerjee; Tiny Nair; Trinath Mishra; U C Samal; U Kaul; V K Chopra; V S Narain; Vimal Raj; Yash Lokhandwala Journal: Indian Heart J Date: 2018-06-08
Authors: Mohammad Javad Hajipour; Mehdi Mehrani; Seyed Hesameddin Abbasi; Ahmad Amin; Seyed Ebrahim Kassaian; Jessica C Garbern; Giulio Caracciolo; Steven Zanganeh; Mitra Chitsazan; Haniyeh Aghaverdi; Seyed Mehdi Kamali Shahri; Aliakbar Ashkarran; Mohammad Raoufi; Holly Bauser-Heaton; Jianyi Zhang; Jochen D Muehlschlegel; Anna Moore; Richard T Lee; Joseph C Wu; Vahid Serpooshan; Morteza Mahmoudi Journal: Chem Rev Date: 2019-09-06 Impact factor: 60.622