Ankeet S Bhatt1, Nancy Luo2, Nicole Solomon2, Neha J Pagidipati2, Giuseppe Ambrosio3, Jennifer B Green2, Darren K McGuire4, Eberhard Standl5, Jan H Cornel6, Sigrun Halvorsen7, Renato D Lopes2, Harvey D White8, Rury R Holman9, Eric D Peterson2, Robert J Mentz10. 1. Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 2. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. 3. Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy. 4. Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX. 5. Diabetes Research Group, Munich Helmholtz Center, Munich, Germany. 6. Noordwest Ziekenhuisgroep, Department of Cardiology, Alkmaar, the Netherlands. 7. Department of Cardiology, Oslo University Hospital, and University of Oslo, Oslo, Norway. 8. Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand. 9. Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom. 10. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Electronic address: robert.mentz@duke.edu.
Abstract
International differences in management/outcomes among patients with type 2 diabetes and heart failure (HF) are not well characterized. We sought to evaluate geographic variation in treatment and outcomes among these patients. METHODS AND RESULTS: Among 14,671 participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), those with HF at baseline and a documented ejection fraction (EF) (N = 1591; 10.8%) were categorized by enrollment region (North America, Latin America, Western Europe, Eastern Europe, and Asia Pacific). Cox models were used to examine the association between geographic region and the primary outcome of all-cause mortality (ACM) or hospitalization for HF (hHF) in addition to ACM alone. Analyses were stratified by those with EF <40% or EF ≥40%. The majority of participants with HF were enrolled in Eastern Europe (53%). Overall, 1,267 (79.6%) had EF ≥40%. β-Blocker (83%) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (86%) use was high across all regions in patients with EF <40%. During a median follow-up of 2.9 years, Eastern European participants had lower rates of ACM/hHF compared with North Americans (adjusted hazard ratio: 0.45; 95% CI: 0.32-0.64). These differences were seen only in the EF ≥40% subgroup and not the EF <40% subgroup. ACM was similar among Eastern European and North American participants (adjusted hazard ratio: 0.79; 95% CI: 0.44-1.45). CONCLUSIONS: Significant variation exists in the clinical features and outcomes of HF patients across regions in TECOS. Patients from Eastern Europe had lower risk-adjusted ACM/hHF than those in North America, driven by those with EF ≥40%. These data may inform the design of future international trials.
International differences in management/outcomes among patients with type 2 diabetes and heart failure (HF) are not well characterized. We sought to evaluate geographic variation in treatment and outcomes among these patients. METHODS AND RESULTS: Among 14,671 participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), those with HF at baseline and a documented ejection fraction (EF) (N = 1591; 10.8%) were categorized by enrollment region (North America, Latin America, Western Europe, Eastern Europe, and Asia Pacific). Cox models were used to examine the association between geographic region and the primary outcome of all-cause mortality (ACM) or hospitalization for HF (hHF) in addition to ACM alone. Analyses were stratified by those with EF <40% or EF ≥40%. The majority of participants with HF were enrolled in Eastern Europe (53%). Overall, 1,267 (79.6%) had EF ≥40%. β-Blocker (83%) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (86%) use was high across all regions in patients with EF <40%. During a median follow-up of 2.9 years, Eastern European participants had lower rates of ACM/hHF compared with North Americans (adjusted hazard ratio: 0.45; 95% CI: 0.32-0.64). These differences were seen only in the EF ≥40% subgroup and not the EF <40% subgroup. ACM was similar among Eastern European and North American participants (adjusted hazard ratio: 0.79; 95% CI: 0.44-1.45). CONCLUSIONS: Significant variation exists in the clinical features and outcomes of HFpatients across regions in TECOS. Patients from Eastern Europe had lower risk-adjusted ACM/hHF than those in North America, driven by those with EF ≥40%. These data may inform the design of future international trials.
Authors: Mohamad Khattab; Purvi Parwani; Mubasher Abbas; Huzair Ali; Pedro M Lozano; Udho Thadani; Tarun W Dasari Journal: J Family Med Prim Care Date: 2020-06-30