Jasper Tromp1, Wouter Ouwerkerk2, John G F Cleland3, Christiane E Angermann4, Ulf Dahlstrom5, Katherine Tiew-Hwa Teng6, Sahiddah Bamadhaj6, Georg Ertl4, Mahmoud Hassanein7, Sergio V Perrone8, Mathieu Ghadanfar9, Anja Schweizer10, Achim Obergfell10, Gerasimos Filippatos11, Sean P Collins12, Carolyn S P Lam13, Kenneth Dickstein14. 1. National Heart Centre Singapore, Singapore; Duke-NUS Medical School Singapore, Singapore; University Medical Centre Groningen, Groningen, the Netherlands. Electronic address: j.tromp01@umcg.nl. 2. National Heart Centre Singapore, Singapore; Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands. 3. Robertson Centre for Biostatistics and Clinical Trials, Institute of Health & Well-Being, University of Glasgow, Scotland; National Heart & Lung Institute, Imperial College, London, United Kingdom. 4. University and University Hospital Würzburg, Comprehensive Heart Failure Center, Würzburg, Germany. 5. Department of Cardiology, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden. 6. National Heart Centre Singapore, Singapore. 7. Alexandria University, Faculty of Medicine, Cardiology Department, Alexandria, Egypt. 8. El Cruce Hospital by Florencio Varela, Lezica Cardiovascular Institute, Sanctuary of the Trinidad Miter, Buenos Aires, Argentina. 9. M-Ghadanfar Consulting Life Sciences, Basel, Switzerland. 10. Novartis Pharma AG, Basel, Switzerland. 11. University of Cyprus, School of Medicine & National and Kapodistrian University of Athens, Athens, Greece; Department of Cardiology, Attikon University Hospital, Athens, Greece. 12. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 13. National Heart Centre Singapore, Singapore; Duke-NUS Medical School Singapore, Singapore. 14. University of Bergen, Stavanger University Hospital, Stavanger, Norway. Electronic address: kenneth.dickstein@med.uib.no.
Abstract
OBJECTIVES: The primary aim of the current study was to investigate global differences in prevalence, association with outcome, and treatment of ischemic heart disease (IHD) in patients with acute heart failure (AHF) in the REPORT-HF (International Registry to Assess Medical Practice With Longitudinal Observation for Treatment of Heart Failure) registry. BACKGROUND: Data on IHD in patients with AHF are primarily from Western Europe and North America. Little is known about global differences in treatment and prognosis of patients with IHD and AHF. METHODS: A total of 18,539 patients with AHF were prospectively enrolled from 44 countries and 365 centers in the REPORT-HF registry. Patients with a history of coronary artery disease, an ischemic event causing admission for AHF, or coronary revascularization were classified as IHD. Clinical characteristics, treatment, and outcomes of patients with and without IHD were explored. RESULTS: Compared with 8,766 (47%) patients without IHD, 9,773 (53%) patients with IHD were older, more likely to have a left ventricular ejection fraction <40% (heart failure with reduced ejection fraction [HFrEF]), and reported more comorbidities. IHD was more common in lower income compared with high-income countries (61% vs. 48%). Patients with IHD from countries with low health care expenditure per capita or without health insurance less likely underwent coronary revascularization or used anticoagulants at discharge. IHD was independently associated with worse cardiovascular death (hazard ratio: 1.21; 95% confidence interval: 1.09 to 1.35). The association between IHD and cardiovascular death was stronger in HFrEF compared with heart failure with preserved ejection fraction (pinteraction <0.001). CONCLUSIONS: In this large global contemporary cohort of patients with AHF, IHD was more common in low-income countries and conveyed worse 1-year mortality, especially in HFrEF. Patients in regions with the greatest burden of IHD were less likely to receive coronary revascularization and treatment for IHD.
OBJECTIVES: The primary aim of the current study was to investigate global differences in prevalence, association with outcome, and treatment of ischemic heart disease (IHD) in patients with acute heart failure (AHF) in the REPORT-HF (International Registry to Assess Medical Practice With Longitudinal Observation for Treatment of Heart Failure) registry. BACKGROUND: Data on IHD in patients with AHF are primarily from Western Europe and North America. Little is known about global differences in treatment and prognosis of patients with IHD and AHF. METHODS: A total of 18,539 patients with AHF were prospectively enrolled from 44 countries and 365 centers in the REPORT-HF registry. Patients with a history of coronary artery disease, an ischemic event causing admission for AHF, or coronary revascularization were classified as IHD. Clinical characteristics, treatment, and outcomes of patients with and without IHD were explored. RESULTS: Compared with 8,766 (47%) patients without IHD, 9,773 (53%) patients with IHD were older, more likely to have a left ventricular ejection fraction <40% (heart failure with reduced ejection fraction [HFrEF]), and reported more comorbidities. IHD was more common in lower income compared with high-income countries (61% vs. 48%). Patients with IHD from countries with low health care expenditure per capita or without health insurance less likely underwent coronary revascularization or used anticoagulants at discharge. IHD was independently associated with worse cardiovascular death (hazard ratio: 1.21; 95% confidence interval: 1.09 to 1.35). The association between IHD and cardiovascular death was stronger in HFrEF compared with heart failure with preserved ejection fraction (pinteraction <0.001). CONCLUSIONS: In this large global contemporary cohort of patients with AHF, IHD was more common in low-income countries and conveyed worse 1-year mortality, especially in HFrEF. Patients in regions with the greatest burden of IHD were less likely to receive coronary revascularization and treatment for IHD.