Global Differences in Burden and Treatment of Ischemic Heart Disease in Acute Heart Failure: REPORT-HF.

OBJECTIVES

The primary aim of the current study was to investigate global differences in prevalence, association with outcome, and treatment of ischemic heart disease (IHD) in patients with acute heart failure (AHF) in the REPORT-HF (International Registry to Assess Medical Practice With Longitudinal Observation for Treatment of Heart Failure) registry.

BACKGROUND

Data on IHD in patients with AHF are primarily from Western Europe and North America. Little is known about global differences in treatment and prognosis of patients with IHD and AHF.

METHODS

A total of 18,539 patients with AHF were prospectively enrolled from 44 countries and 365 centers in the REPORT-HF registry. Patients with a history of coronary artery disease, an ischemic event causing admission for AHF, or coronary revascularization were classified as IHD. Clinical characteristics, treatment, and outcomes of patients with and without IHD were explored.

RESULTS

Compared with 8,766 (47%) patients without IHD, 9,773 (53%) patients with IHD were older, more likely to have a left ventricular ejection fraction <40% (heart failure with reduced ejection fraction [HFrEF]), and reported more comorbidities. IHD was more common in lower income compared with high-income countries (61% vs. 48%). Patients with IHD from countries with low health care expenditure per capita or without health insurance less likely underwent coronary revascularization or used anticoagulants at discharge. IHD was independently associated with worse cardiovascular death (hazard ratio: 1.21; 95% confidence interval: 1.09 to 1.35). The association between IHD and cardiovascular death was stronger in HFrEF compared with heart failure with preserved ejection fraction (p

CONCLUSIONS

In this large global contemporary cohort of patients with AHF, IHD was more common in low-income countries and conveyed worse 1-year mortality, especially in HFrEF. Patients in regions with the greatest burden of IHD were less likely to receive coronary revascularization and treatment for IHD.

Informations de copyright

Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures REPORT-HF was funded by Novartis. Dr. Lam is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from Boston Scientific, Bayer, Roche Diagnostics, AstraZeneca, Medtronic, and Vifor Pharma; has served as consultant or on the Advisory Board/Steering Committee/Executive Committee for Boston Scientific, Bayer, Roche Diagnostics, AstraZeneca, Medtronic, Vifor Pharma, Novartis, Amgen, Merck, Janssen Research & Development LLC, Menarini, Boehringer Ingelheim, Novo Nordisk, Abbott Diagnostics, Corvia, Stealth BioTherapeutics, Jana Care, Biofourmis, Darma, Applied Therapeutics, MyoKardia, Cytokinetics, WebMD Global LLC, Radcliffe Group Ltd., and Corpus; and serves as co-founder and non-executive director of eKo.ai. Dr. Tromp has received personal grants and speaker fees from Olink Proteomics and Roche Diagnostics. Dr. Filippatos has received research grants from the European Union; committee fees from Novartis related to REPORT-HF; and committee membership in trials and/or registries sponsored by Servier, Boehringer Ingelheim, Medtronic, and Vifor. Dr. Angermann has received grants, personal fees, and other from Novartis; and further acknowledges nonfinancial support from the University Hospital Würzburg, nonfinancial support from the Comprehensive Heart Failure Center Würzburg, and grant support from the German Ministry for Education and Research. Dr. Dahlstrom has received research support from AstraZeneca, Pfizer, Boehringer Ingelheim, Vifor, Roche Diagnostics, and Boston Scientific; and speaker honoraria and consultancies from AstraZeneca, Novartis, and Amgen. Dr. Hassanein has received honoraria as a lecturer from Novartis, Aventis, Amgen, MSD, AstraZeneca, and Merck. Dr. Collins has received research grants from the National Institutes of Health, the Agency for Healthcare Research and Quality, the American Heart Association, and the Patient-Centered Outcomes Research Institute; and consulting fees from Novartis, Medtronic, Vixiar, and Ortho Clinical. Drs. Ghadanfar, Schweizer, and Obergfell are employed by Novartis. Dr. Cleland has received grants and personal fees from Amgen, Philips, Bayer, Bristol-Myers Squibb, Stealth Biopharmaceuticals, and Torrent Pharmaceuticals; personal fees from AstraZeneca, MyoKardia, Sanofi, Servier, and Abbott; grants, personal fees, and nonfinancial support from Medtronic, Novartis, and Vifor; and grants and nonfinancial support from Pharmacosmos and Pharma Nord. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.