Repositorio
Institucional

Yusuf, Salim

Joseph, Philip

Roy, Ambuj

Lonn, Eva

Stoerk, Stefan

Floras, John

Mielniczuk, Lisa

Rouleau, Jean-Lucien

Zhu, Jun

Dzudie, Anastase

Balasubramanian, Kumar

Karaye, Kamilu

AlHabib, Khalid F.

Gomez-Mesa, Juan Esteban

Branch, Kelley R.

Makubi, Abel

Budaj, Andrzej

Avezum, Alvaro

Wittlinger, Thomas

Ertl, Georg

Mondo, Charles

Pogosova, Nana

Maggioni, Aldo Pietro

Orlandini, Andres

Parkhomenko, Alexander

ElSayed, Ahmed

Lopez-Jaramillo, Patricio

Grinvalds, Alex

Temizhan, Ahmet

Hage, Camilla

Lund, Lars H.

Kazmi, Khawar

Lanas, Fernando

Sharma, Sanjib Kumar

Fox, Keith

McMurray, John J. V.

Leong, Darryl

Dokainish, Hisham

Khetan, Aditya

Yonga, Gerald

Kragholm, Kristian

Shaker, Kerolos Wagdy

Mwita, Julius Chacha

Al Mulla, Arif Abudullatif

Alla, Francois

Damasceno, Albertino

Silva-Cardoso, Jose

Dans, Antonio L.

Sliwa, Karen

O'Donnell, Martin

Bazargani, Nooshin

Bayes-Genis, Antoni

McCready, Tara

Probstfield, Jeffrey

Global Variations in Heart Failure Etiology, Management, and Outcomes

AMER MEDICAL ASSOC

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

en

Importance Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants Multinational HF registry of 23341 participants in 40 high-income, upper-middle-income, lower-middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures HF cause, HF medication use, hospitalization, and death. Results Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a beta-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper-middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower-middle-income countries (39.5%) (P<.001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper-middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower-middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio=3.8) and in upper-middle-income countries (ratio=2.4), similar in lower-middle-income countries (ratio=1.1), and less frequent in low-income countries (ratio=0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper-middle-income countries (9.7%), then lower-middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower-middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.

2023

artículo original

10.1001/jama.2023.5942

PDF

Aged

Causality

Developed Countries / economics

Developed Countries / statistics & numerical data

Developing Countries / economics

Developing Countries / statistics & numerical data

Female

Global Health / statistics & numerical data

Heart Failure / epidemiology

Heart Failure / etiology

Heart Failure / mortality

Heart Failure / therapy

Hospitalization / economics

Hospitalization / statistics & numerical data

Humans

Hypertension / complications

Hypertension / epidemiology

Income

Male

Middle Aged

Registries / statistics & numerical data

Stroke Volume

Medicina general e interna

Envejecido

Causalidad

Países Desarrollados / economía

Países desarrollados / estadísticas y datos numéricos

Países en desarrollo / economía

Países en desarrollo / estadísticas y datos numéricos

Femenino

Salud Global / estadísticas y datos numéricos

Insuficiencia Cardíaca/epidemiología

Insuficiencia Cardíaca/etiología

Insuficiencia Cardíaca/mortalidad

Insuficiencia cardíaca/terapia

Hospitalización/economía

Hospitalización/estadísticas y datos numéricos

Humanos

Hipertensión/complicaciones

Hipertensión/epidemiología

Ingreso

Masculino

De edad mediana

Registros/estadísticas y datos numéricos

Volumen sistólico

1650.0

1661

artículo original

versión publicada

acceso abierto

acceso abierto

WOS:001053900200020

0098-7484

verde

Medicina general e interna