Regional Variation of Mortality in Heart Failure With Reduced and Preserved Ejection Fraction Across Asia: Outcomes in the ASIAN‐HF Registry

Abstract

Background Data comparing outcomes in heart failure ( HF ) across Asia are limited. We examined regional variation in mortality among patients with HF enrolled in the ASIAN ‐HF (Asian Sudden Cardiac Death in Heart Failure) registry with separate analyses for those with reduced ejection fraction ( EF ; <40%) versus preserved EF (≥50%). Methods and Results The ASIAN ‐ HF registry is a prospective longitudinal study. Participants with symptomatic HF were recruited from 46 secondary care centers in 3 Asian regions: South Asia (India), Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore), and Northeast Asia (South Korea, Japan, Taiwan, Hong Kong, China). Overall, 6480 patients aged >18 years with symptomatic HF were recruited (mean age: 61.6±13.3 years; 27% women; 81% with HF and reduced r EF ). The primary outcome was 1‐year all‐cause mortality. Striking regional variations in baseline characteristics and outcomes were observed. Regardless of HF type, Southeast Asians had the highest burden of comorbidities, particularly diabetes mellitus and chronic kidney disease, despite being younger than Northeast Asian participants. One‐year, crude, all‐cause mortality for the whole population was 9.6%, higher in patients with HF and reduced EF (10.6%) than in those with HF and preserved EF (5.4%). One‐year, all‐cause mortality was significantly higher in Southeast Asian patients (13.0%), compared with South Asian (7.5%) and Northeast Asian patients (7.4%; P <0.001). Well‐known predictors of death accounted for only 44.2% of the variation in risk of mortality. Conclusions This first multinational prospective study shows that the outcomes in Asian patients with both HF and reduced or preserved EF are poor overall and worst in Southeast Asian patients. Region‐specific risk factors and gaps in guideline‐directed therapy should be addressed to potentially improve outcomes. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 01633398.

Post-discharge prognosis of patients admitted to hospital for heart failure by world region, and national level of income and income disparity (REPORT-HF): a cohort study

“…In Asia, data from the ASIAN-HF registry showed a 1-year all-cause mortality of 13% for patients with either HFpEF or HFrEF enrolled as in-patients. 24 Patients with acute heart failure enrolled in the Trivandrum Heart Failure Registry 25 southeast Asia (23%), and China (17%) were consistent with or exceeded those reported for patients enrolled in hospital in INTER-CHF. 4 We suggest that any differences in mortality in other registries and those in REPORT-HF might be due to differences in centres included, proportion of patients dwelling in rural areas, and the need for patients to consent to partici pation.…”

“…Over [22][23][24][25][26][27] vs 28 [24][25][26][27][28][29][30][31][32][33][34]) and were more often admitted with a first episode of heart failure. Despite their relative youth, patients from lower-middle-income countries were in a worse (ie, higher) New York Heart Association class class, more often had HFrEF, and generally had worse signs and symptoms.…”

Clinical and Hospital Factors Affecting Treatment with Primary Prevention Implantable Cardioverter-Defibrillators in Ischemic Cardiomyopathy Patients

“…Despite the existence of evidence-based and well-established national guidelines, PP ICD implant rates vary among countries and are low in Asian countries. 17 29 Previous studies reported that PP ICD implantation rates for eligible patients were 10%, 60%, and 5% in Sweden, US, and an Asian country, respectively. 25 26 29 The present study showed that only 5.23% of patients who were eligible for PP ICD were treated with ICDs.…”

“…17 29 Previous studies reported that PP ICD implantation rates for eligible patients were 10%, 60%, and 5% in Sweden, US, and an Asian country, respectively. 25 26 29 The present study showed that only 5.23% of patients who were eligible for PP ICD were treated with ICDs. We could not evaluate whether electrophysiology study was performed in patients whose LVEF was over 35% according to guidelines because of the multicenter study design.…”

“… 18 19 20 21 22 23 24 The underuse of ICD and cardiac resynchronization therapy with a defibrillator is an issue in Asian countries. 25 26 27 28 29 Collaboration between interventionists and electrophysiologists may facilitate ICD implantation in eligible patients. This study investigated ICD implantation rates and factors associated with appropriate PP ICD implants for ICM using data from a prospective multicenter registry.…”