IHD in HF Patients Associated With Higher Prevalence, Poorer Outcomes in Lower-Income Countries

The prevalence of ischemic heart disease (IHD) among patients hospitalized for heart failure (HF) is higher and associated with poorer outcomes in lower-income vs. higher-income countries, according to a study published April 7 in JACC: Heart Failure.

Jasper Tromp, MD, PhD, et al., looked at global differences in prevalence, outcomes and treatment of IHD in 18,539 patients with acute HF from 365 centers in 44 countries in the REPORT-HF trial. Patients who had a history of coronary artery disease, an ischemic event requiring hospitalization for acute HF or coronary revascularization were classified as having IHD.

Of the 18,539 patients, 9,773 (53%) had IHD. Patients with IHD were older, more likely to be male, less likely to present with new-onset HF, had a higher NYHA class before admission and more likely to have left ventricular ejection fraction (LVEF) <50%. In addition, a history of hypertension, anemia, diabetes, chronic kidney disease and smoking were more common in patients with IHD. When stratified to country income level, IHD prevalence was higher (p<0.001) in low-income (61%) vs. high-income (48%) countries. IHD was more prevalent in countries like China (56%) and India (60%) vs. the U.S. (48%) and was more common in Eastern Europe, Southeast Asia and the Western Pacific.

Results showed that patients with IHD from countries with low per capita health care expenditures or who did not have health insurance were less likely to undergo coronary revascularization or receive anticoagulants at discharge. After one year, patients with IHD were more likely to die from cardiovascular causes vs. those without IHD (hazard ratio: 1.21; 95% confidence interval: 1.09-1.35). The association between IHD and cardiovascular death was stronger in patients with HF with reserved ejection fraction (HFrEF) vs. HF with preserved ejection fraction (p<0.001).

According to the researchers, the findings "highlight the increasing burden of IHD in patients hospitalized for [acute] HF from lower-income regions and suggest that efforts to improve quality of treatment are warranted." They add that IHD in patients with acute HF is associated with higher one-year mortality, especially in patients with HFrEF, and patients without health insurance or those from regions with lower health care expenditures are less likely to receive beta blockers, CABG or PCI. "Initiatives are required to improve the implementation of lifesaving therapies globally, especially in vulnerable patient groups in low-income countries," they conclude.

Clinical Topics: Anticoagulation Management, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Coronary Artery Disease, Hypertension, Smoking

Keywords: Stroke Volume, Health Expenditures, Heart Failure, Coronary Artery Disease, Prevalence, Patient Discharge, Anticoagulants, Percutaneous Coronary Intervention, Ventricular Function, Left, Myocardial Ischemia, Hospitalization, Adrenergic beta-Antagonists, Income, Insurance, Health, Anemia, Smoking, Renal Insufficiency, Chronic, Asia, Southeastern, Hypertension, Diabetes Mellitus, Coronary Artery Bypass, ACC International

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