1 research outputs found
Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study
Background Most data on mortality and prognostic factors in patients with heart failure come from North America
and Europe, with little information from other regions. Here, in the International Congestive Heart Failure (INTERCHF)
study, we aimed to measure mortality at 1 year in patients with heart failure in Africa, China, India, the Middle
East, southeast Asia and South America; we also explored demographic, clinical, and socioeconomic variables
associated with mortality.
Methods We enrolled consecutive patients with heart failure (3695 [66%] clinic outpatients, 2105 [34%] hospital in
patients) from 108 centres in six geographical regions. We recorded baseline demographic and clinical characteristics
and followed up patients at 6 months and 1 year from enrolment to record symptoms, medications, and outcomes.
Time to death was studied with Cox proportional hazards models adjusted for demographic and clinical variables,
medications, socioeconomic variables, and region. We used the explained risk statistic to calculate the relative
contribution of each level of adjustment to the risk of death.
Findings We enrolled 5823 patients within 1 year (with 98% follow-up). Overall mortality was 16·5%: highest in Africa
(34%) and India (23%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the
Middle East (9%). Regional differences persisted after multivariable adjustment. Independent predictors of mortality
included cardiac variables (New York Heart Association Functional Class III or IV, previous admission for heart
failure, and valve disease) and non-cardiac variables (body-mass index, chronic kidney disease, and chronic obstructive
pulmonary disease). 46% of mortality risk was explained by multivariable modelling with these variables; however,
the remainder was unexplained.
Interpretation Marked regional differences in mortality in patients with heart failure persisted after multivariable
adjustment for cardiac and non-cardiac factors. Therefore, variations in mortality between regions could be the result
of health-care infrastructure, quality and access, or environmental and genetic factors. Further studies in large, global
cohorts are needed