National Heart Centre Singapore, Singapore; Duke-National University of Singapore, Singapore; University Medical Centre Groningen, Groningen, Netherlands.
National Heart Centre Singapore, Singapore.
Lancet Glob Health. 2020 Mar;8(3):e411-e422. doi: 10.1016/S2214-109X(20)30004-8.
Heart failure is a global public health problem, affecting a large number of individuals from low-income and middle-income countries. REPORT-HF is, to our knowledge, the first prospective global registry collecting information on patient characteristics, management, and prognosis of acute heart failure using a single protocol. The aim of this study was to investigate differences in 1-year post-discharge mortality according to region, country income, and income inequality.
Patients were enrolled during hospitalisation for acute heart failure from 358 centres in 44 countries on six continents. We stratified countries according to a modified WHO regional classification (Latin America, North America, western Europe, eastern Europe, eastern Mediterranean and Africa, southeast Asia, and western Pacific), country income (low, middle, high) and income inequality (according to tertiles of Gini index). Risk factors were identified on the basis of expert opinion and knowledge of the literature.
Of 18 102 patients discharged, 3461 (20%) died within 1 year. Important predictors of 1-year mortality were old age, anaemia, chronic kidney disease, presence of valvular heart disease, left ventricular ejection fraction phenotype (heart failure with reduced ejection fraction [HFrEF] vs preserved ejection fraction [HFpEF]), and being on guideline-directed medical treatment (GDMT) at discharge (p<0·0001 for all). Patients from eastern Europe had the lowest 1-year mortality (16%) and patients from eastern Mediterranean and Africa (22%) and Latin America (22%) the highest. Patients from lower-income countries (ie, ≤US$3955 per capita; hazard ratio 1·58, 95% CI 1·41-1·78), or with greater income inequality (ie, from the highest Gini tertile; 1·25, 1·13-1·38) had a higher 1-year mortality compared with patients from regions with higher income (ie, >$12 235 per capita) or lower income inequality (ie, from the lowest Gini tertile). Compared with patients with HFrEF, patients with HFpEF had a lower 1-year mortality with little variation by income level (p for HFrEF vs HFpEF <0·0001).
Acute heart failure is associated with a high post-discharge mortality, particularly in patients with HFrEF from low-income regions with high income inequality. Regional differences exist in the proportion of eligible patients discharged on GDMT, which was strongly associated with mortality and might reflect lack of access to post-discharge care and prescribing of GDMT.
Novartis Pharma.
心力衰竭是一个全球性的公共卫生问题，影响了来自低收入和中等收入国家的大量人群。据我们所知，REPORT-HF 是首个使用单一方案收集急性心力衰竭患者特征、管理和预后信息的全球前瞻性登记研究。本研究的目的是根据区域、国家收入和收入不平等情况，研究出院后 1 年死亡率的差异。
358 个中心来自六大洲的 44 个国家在急性心力衰竭住院期间招募了患者。我们根据世界卫生组织（WHO）区域分类（拉丁美洲、北美洲、西欧、东欧、东地中海和非洲、东南亚和西太平洋）、国家收入（低、中、高）和收入不平等（基尼指数的三分位数）对国家进行分层。根据专家意见和文献知识确定了风险因素。
在出院的 18102 名患者中，3461 名（20%）在 1 年内死亡。1 年死亡率的重要预测因素是年龄较大、贫血、慢性肾脏病、存在瓣膜性心脏病、左心室射血分数表型（心力衰竭射血分数降低[HFrEF]与射血分数保留[HFpEF]）和出院时接受指南指导的药物治疗（GDMT）（所有因素 p<0·0001）。东欧患者的 1 年死亡率最低（16%），东地中海和非洲（22%）和拉丁美洲（22%）患者的死亡率最高。来自低收入国家（即人均≤3955 美元）或收入不平等程度较高（即来自基尼系数最高三分位数）的患者（危险比 1·58，95%CI 1·41-1·78）与来自收入较高地区（即人均>12235 美元）或收入不平等程度较低（即来自基尼系数最低三分位数）的患者相比，1 年死亡率更高。与 HFrEF 患者相比，HFpEF 患者的 1 年死亡率较低，且受收入水平影响较小（HFrEF 与 HFpEF 比较 p<0·0001）。
急性心力衰竭患者出院后死亡率较高，特别是来自收入不平等程度较高的低收入地区的 HFrEF 患者。在接受 GDMT 出院的合格患者比例方面存在区域差异，这与死亡率密切相关，可能反映了缺乏出院后护理和 GDMT 处方的机会。
诺华制药。
