Income level and inequality as complement to geographical differences in cardiovascular trials

Ferreira, João Pedro; Rossignol, Patrick; Dewan, Pooja; Lamiral, Zohra; White, William B.; Pitt, Bertram; McMurray, John J.V.; Zannad, Faı̈ez

doi:10.1016/j.ahj.2019.08.019

Cited by 23 publications

(9 citation statements)

References 30 publications

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“…In the Prospective Urban Rural Epidemiological study, the major cardiovascular event rates were higher in middle- and low-income countries than in high-income countries, despite a lower risk-factor burden in low-middle income countries [ 23 ]. Furthermore, patients with AHF from low-middle income countries with large socioeconomic inequalities had relatively high mortality rates and poor HF outcomes [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Acute myocardial infarction and acute heart failure in the Middle East and North Africa: Study design and pilot phase study results from the PEACE MENA registry

et al. 2020

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Background This pilot study describes the overall design and results of the Program for the Evaluation and Management of the Cardiac Events registry for the Middle East and North Africa (MENA) Region. Methods This prospective, multi-center, multi-country study included patients hospitalized with acute myocardial infarction (AMI) and/or acute heart failure (AHF). We evaluated the clinical characteristics, socioeconomic and educational levels, management, in-hospital outcomes, and 30-day mortality rate of patients that were admitted to one tertiary-care center in each of 14 Arab countries in the MENA region. Results Between 22 April and 28 August 2018, 543 AMI and 381AHF patients were enrolled from 14 Arab countries (mean age, 57±12 years, 82.5% men). Over half of the patients in both study groups had low incomes with limited health care coverage, and limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia.

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Section: Discussionmentioning

confidence: 99%

Acute myocardial infarction and acute heart failure in the Middle East and North Africa: Study design and pilot phase study results from the PEACE MENA registry

et al. 2020

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“…An extreme example of such an occurrence was reported in the TOPCAT trial in which event rates outside the Americas were found to be substantially lower than those in the Americas 59 . It is possible that the globalization of clinical trials and the shift of recruitment to countries in which health care and general GDP per capita are lower 60 are resulting in the creation of incentives that may lead some to enrol patients who have milder cases of HF or none in pursuit of financial gain. In any case, the combination of a reduced event rate and reduced treatment effect leads to substantially reduced power and fewer positive trials.…”

Section: Discussionmentioning

confidence: 99%

Mega‐trials in heart failure: effects of dilution in examination of new therapies

Davison

Takagi

Senger

et al. 2020

European J of Heart Fail

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“…46,47 Analysis of HF patients from lower-income to middleincome and high-inequality countries has showed higher mortality rates than those patients from high-income and low-inequality countries. 48 In developing countries such as Mexico, unfavourable social circumstances, along with inadequate and inefficient public spending on health care, can present considerable barriers to improving outcomes in patients with AHF. 49 There is a need to develop more practical strategies to improve adherence to guidelines.…”

Section: Discussionmentioning

confidence: 99%

Clinical phenotypes, aetiologies, management, and mortality in acute heart failure: a single‐institution study in Latin‐America

et al. 2020

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Aims Little is known regarding acute heart failure (AHF) clinical characteristics and its hospital outcome in Latin America. This study sought to assess the prevalence of, and identify differences among, in‐hospital outcomes in patients hospitalized for AHF who were stratified by clinical phenotype at a hospital in Latin America. Methods and results This is a retrospective cohort study of patients with AHF who were hospitalized in the coronary care unit of a Latin American teaching hospital from January 2006 to December 2018. Cox regression analysis was used to identify predictors of mortality. Of 21 042 patients admitted, 7759 (36.6%) had AHF. Their median age was 62 years, and 35% were women. De novo heart failure was seen in 39.4% of patients. Most common was AHF‐associated acute coronary syndromes (ACS‐HF) in 43.0%, decompensated heart failure (DHF) in 33.7%, hypertensive heart failure (HT‐HF) in 11.8%, and cardiogenic shock (CS) in 5.2%. Pulmonary oedema (PO) (3.3%) and right heart failure (RHF) (3.0%) were least frequent. Coronary artery disease was the most frequent aetiology in 56.5% of patients, valvular heart disease in 22.4%, and cardiomyopathies in 12.3%. Other less frequent aetiology included adult congenital heart disease (2.5%), lung diseases (2.1%), acute aortic syndromes (1.4%), pericardial diseases (0.8%), and intracardiac tumours (0.3%). Aetiology could not be established in 1.6% of patients. Before admission, patients with worsening chronic heart failure and reduced ejection fraction were treated with renin–angiotensin system blockers (60.4%), beta‐blockers (42.5%), or spironolactone (34.4%). The percentages of patients given in‐hospital management with intravenous diuretics, vasodilators, inotropes, and vasopressors were 81.2%, 33.4%, 18.9%, and 20.4%, respectively. The overall in‐hospital mortality was 17.9% (71.3%, 43.9%, 23.8%, 14.9%, 13.6%, and 10.1% for CS, PO, RHF, DHF, ACS‐HF, and HT‐HF, respectively; P < 0.0001). Multivariate analysis revealed that PO (hazard ratio [HR] 2.68, 95% confidence interval [CI] 1.73–4.14, P < 0.0001) and CS (HR 3.37, 95% CI 2.12–5.35, P < 0.0001) were independent predictors of in‐hospital mortality. Use of intravenous diuretics was linked to reduction of in‐hospital mortality (HR 0.70, 95% CI 0.59–0.59, P < 0.0001). By contrast, increased in‐hospital mortality was associated with the use of intravenous inotrope or vasopressor (HR 1.49, 95% CI 1.27–1.76 and HR 2.91, 95% CI 2.41–3.51, P < 0.0001, respectively). Conclusions Real‐world evidence from a university hospital in Latin America shows that the high mortality among patients with AHF may depend, among other factors, on patients' AHF clinical phenotypes. The clinical characteristics and aetiologies of AHF appear to differ between these data from Mexico and those from European and US registries.

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Income level and inequality as complement to geographical differences in cardiovascular trials

Cited by 23 publications

References 30 publications

Acute myocardial infarction and acute heart failure in the Middle East and North Africa: Study design and pilot phase study results from the PEACE MENA registry

Acute myocardial infarction and acute heart failure in the Middle East and North Africa: Study design and pilot phase study results from the PEACE MENA registry

Mega‐trials in heart failure: effects of dilution in examination of new therapies

Clinical phenotypes, aetiologies, management, and mortality in acute heart failure: a single‐institution study in Latin‐America

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