650 Variation in Quality of Care Among Patients Hospitalized With Acute Heart Failure in an International Trial: Findings From ASCEND-HF

Do Heart Failure Clinics Have to Reinvent Themselves to Remain Germane?

“…9 This limited access to timely HF resources, along with absence of coordination in patient care, remain the main obstacles for high-quality HF management and lead to substandard implementation of evidence-based therapies. 11 Furthermore, poor access creates missed opportunities, such as in the setting of a large myocardial infarction, for which time is critical to modifying the ongoing remodelling process, or in the delay of referral for implantation of a life-saving therapy such as a defibrillator.…”

Defining Regions in Multiregional Clinical Trials: An Analytical Approach to Considering Impact of Intrinsic and Extrinsic Factors

“…Of the 82 potentially relevant publications identified, many discussed the same trial. We reviewed and summarized the 20 unique studies 14 –33 that described geographic variations in outcomes with particular attention to intrinsic or extrinsic factors which potentially contributed to the observed differences. These 20 studies are listed in Table 1.…”

“…Most of the studies (18 of 20) were reviewed in the cardiovascular (CV) and renal area. 14 –25,27 –32 Among extrinsic factors, clinical practice/diagnostic capabilities was the leading factor considered potentially contributory to differences in clinical outcomes or measures. Other notable extrinsic factors included investigator site factors.…”

“…It was difficult to accurately identify regions/countries more likely to have inconsistent treatment outcomes, as not all regions/countries were included in all studies, and regions were not consistently defined. However, it was noted that the US and North America (NA) were included in 15 of the 20 selected unique studies we reviewed, 14 –16,19 –29,32 of which 3 23,27,29 reported the US/NA as having more favorable treatment outcomes relative to other regions/countries and 6 14,16,19,21,22,28 reported the US/NA with more unfavorable treatment outcomes relative to other regions/countries. These favorable/unfavorable classifications were mostly post hoc assessments and were rarely related to prespecified definitions of consistency, so such caveats applied when considering “favorable” classifications.…”

Heart Failure: An Overview of Morbidity and Mortality in Rio Grande do Sul

“…Data from Porto Alegre are similar to those from an international multicenter trial designed to assess HF patients in 388 centers in North America, Europe, Latin America and Asia, in which the mean age was 67 years. 16 In two previous studies that assessed HF patients in low-income countries, the mean age was 52 to 59 years. 11,17 Regional variation in age may be explained by differences in the prevalence of underlying risk factors, as well as living standards.…”