European Society of Cardiology guidelines and 1 year outcomes of acute heart failure treatment in Central Asia and Europe

Abstract

AimsOutcomes reported for patients with hospitalization for acute heart failure (AHF) treatment vary worldwide. Ethnicity‐associated characteristics may explain this observation. This observational study compares characteristics and 1‐year outcomes of Kyrgyz and Swiss AHF patients against the background of European Society of Cardiology guidelines‐based cardiovascular care established in both countries.Methods and resultsThe primary endpoint was 1 year all‐cause mortality (ACM); the secondary endpoint was 1 year ACM or HF‐related rehospitalization. A total of 538 Kyrgyz and 537 Swiss AHF patients were included. Kyrgyz patients were younger (64.0 vs. 83.0 years, P < 0.001); ischaemic or rheumatic heart disease and chronic obstructive pulmonary disease were more prevalent (always P < 0.001). In Swiss patients, smoking, dyslipidaemia, hypertension, and atrial flutter/fibrillation were more frequent (always P ≤ 0.035); moreover, left ventricular ejection fraction (LVEF) was higher (47% vs. 36%; P < 0.001), and >mild aortic stenosis was more prevalent (P < 0.001). Other valvular pathologies were more prevalent in Kyrgyz patients (P < 0.001). At discharge, more Swiss patients were on vasodilatory treatment (P < 0.006), while mineralocorticoid receptor antagonists (P = 0.001), beta‐blockers (P = 0.001), or loop diuretics (P < 0.001) were less often prescribed. In Kyrgyz patients, unadjusted odds for the primary and secondary endpoints were lower [odds ratio (OR) 0.68, 95% confidence interval (CI): 0.51–0.90, P = 0.008; OR 0.72, 95% CI: 0.56–0.91, P = 0.006, respectively]. After adjustment for age and LVEF, no difference remained (primary endpoint: OR 1.03, 95% CI: 0.71–1.49, P = 0.894; secondary endpoint: OR 0.82, 95% CI: 0.60–1.12, P = 0.206).ConclusionsOn the background of identical guidelines, age‐ and LVEF‐adjusted outcomes were not different between Central Asian and Western European AHF patients despite of large ethnical disparity.

The prescription of beta-blockers in older patients with heart failure with reduced ejection fraction: an observational study in Vietnam

“…In a study of 1825 patients (mean age 77.3 ± 13.2) admitted for heart failure for the first time between 2009 and 2011 in France, the prescription rates of beta-blockers before admission ranged from 26 to 32%, and 46–54% at discharge 20 . In a study of 1075 patients with heart failure (age range 62–84) in Central Asia and Europe in the period 2013–2019, the rates of beta-blocker use at admission in patients with HFrEF ranged from 43.5% in Central Asia to 59.1% in Europe 21 . In a study of 1509 patients (mean age 63.9 ± 16.1) hospitalized for acute HFrEF in 21 hospitals in Taiwan in 2014, 60% were prescribed beta-blockers at discharge 22 .…”