2019
DOI: 10.1016/j.ahj.2019.08.019
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Income level and inequality as complement to geographical differences in cardiovascular trials

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Cited by 23 publications
(9 citation statements)
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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%
“…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%
“…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%
“…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%