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

Michael R MacDonald, Wan Ting Tay, Tiew-Hwa Katherine Teng, Inder Anand, Lieng Hsi Ling, Jonathan Yap, Jasper Tromp, Gurpreet S Wander, Ajay Naik, Tachapong Ngarmukos, Bambang B Siswanto, Chung-Lieh Hung, A Mark Richards, Carolyn S P Lam, ASIAN‐F investigators †, ASIAN‐F investigators†, Houng Bang Liew, Calambur Narasimhan, Sang Weon Park, Eugenio Reyes, Wataru Shimizu, Shu Zhang, Liqun Wu, Tianyou Ling, Xinli Li, Haifeng Zhang, Yangang Su, Cheuk Man Yu, B K S Sastry, Arun Gopi, K Raghu, C Sridevi, Daljeet Kaur, Keyur Parikh, Anish Chandarana, Urmil Shah, Milan Chag, Hemang Baxi, Satya Gupta, Jyoti Bhatia, Vaishali Khakhkhar, Vineet Sankhla, Tejas Patel, Vipul Kapoor, Rohit Tandon, Vijay Chopra, Manoj Kumar, Hatinder Jeet Singh Sethi, Rashmi Verma, Jitendra Sawhney, Manish Kr Sharma, Mohanan Padinhare Purayil, Muhammad Munawar, Jimmy Agung Pambudi, Antonia Lukito, Ingrid Pardede, Alvin Thengker, Vito Damay, Siska Suridanda Danny, Rarsari Surarso, Ryoubun Yasuoka, Kuniya Asai, Takanori Ikeda, Sang-Weon Park, Suk Keun Hong, SookJin Lee, Lim Dal Soo, Dong-Hyeok Kim, Jaemin Shim, Seong-Mi Park, Seung-Young Roh, Young Hoon Kim, Mina Kim, Jong-Il Choi, Jin Oh Na, Seung Woon Rha, Hong Seog Seo, Dong Joo Oh, Chang Gyu Park, Eung Ju Kim, Sunki Lee, Boyoung Joung, Jae-Sun Uhm, Moon Hyoung Lee, In-Jeong Cho, Hui-Nam Park, Hyung-Wook Park, Jeong-Gwan Cho, Namsik Yoon, KiHong Lee, Kye Hun Kim, Seong Hwan Kim, Houng Bang Liew, Sahrin Saharudin, Boon Cong Beh, Yu Wei Lee, Chia How Yen, Mohd Khairi Othman, Amie-Anne Augustine, Mohd Hariz Mohd Asnawi, Roberto Angelo Mojolou, You Zhuan Tan, Aida Nurbaini Arbain, Chii Koh Wong, Azmee Mohd Ghazi, Surinder Kaur Khelae, David S P Chew, Lok Bin Yap, Azlan Hussin, Zulkeflee Muhammad, Imran Zainal Abidin, Ahmad Syadi Bin Mahmood Zhudi, Nor Ashikin Md Sari, Ganiga Srinivasaiah Sridhar, Ahmad Syadi Mahmood Zuhdi, Muhammad Dzafir Ismail, Tiong Kiam Ong, Yee Ling Cham, Ning Zan Khiew, Asri Bin Said, Alan Yean Yip Fong, Nor Hanim Mohd Amin, Keong Chua Seng, Sian Kong Tan, Kuan Leong Yew, Eugenio Reyes, Jones Santos, Allan Lim, Raul Lapitan, Ryan Andal, Eleanor Lopez, Kheng Leng David Sim, Boon Yew Tan, Choon Pin Lim, Louis L Y Teo, Laura L H Chan, Ping Chai, Ching Chiew Raymond Wong, Kian Keong Poh, Poh Shuan Daniel Yeo, Evelyn M Lee, Seet Yong Loh, Min Er Ching, Deanna Z L Khoo, Min Sen Yew, Wenjie Huang, Jia Hao Jason See, Yaozong Benji Lim, Svenszeat Tan, Colin Yeo, Siang Chew Chai, Fazlur Rehman Jaufeerally, Haresh Tulsidas, Than Aung, Hean Yee Ong, Lee Fong Ling, Dinna Kar Nee Soon, Hung-I Yeh, Jen-Yuan Kuo, Chih-Hsuan Yen, Juey-Jen Hwang, Kuo-Liong Chien, Ta-Chen Su, Lian-Yu Lin, Jyh-Ming Juang, Yen-Hung Lin, Fu-Tien Chiang, Jiunn-Lee Lin, Yi-Lwun Ho, Chii-Ming Lee, Po-Chih Lin, Chi-Sheng Hung, Sheng-Nan Chang, Jou-Wei Lin, Chih-Neng Hsu, Wen-Chung Yu, Tze-Fan Chao, Shih-Hsien Sung, Kang-Ling Wang, Hsin-Bang Leu, Yenn-Jiang Lin, Shih-Lin Chang, Po-Hsun Huang, Li-Wei Lo, Cheng-Hsueh Wu, Hsin-Yueh Liang, Shih-Sheng Chang, Lien-Cheng Hsiao, Yu-Chen Wang, Chiung-Ray Lu, Hung-Pin Wu, Yen-Nien Lin, Ke-Wei Chen, Ping-Han Lo, Chung-Ho Hsu, Li-Chuan Hsieh, Mann Chandavimol, Teerapat Yingchoncharoen, Prasart Laothavorn, Wanwarang Wongcharoen, Arintaya Phrommintikul, Michael R MacDonald, Wan Ting Tay, Tiew-Hwa Katherine Teng, Inder Anand, Lieng Hsi Ling, Jonathan Yap, Jasper Tromp, Gurpreet S Wander, Ajay Naik, Tachapong Ngarmukos, Bambang B Siswanto, Chung-Lieh Hung, A Mark Richards, Carolyn S P Lam, ASIAN‐F investigators †, ASIAN‐F investigators†, Houng Bang Liew, Calambur Narasimhan, Sang Weon Park, Eugenio Reyes, Wataru Shimizu, Shu Zhang, Liqun Wu, Tianyou Ling, Xinli Li, Haifeng Zhang, Yangang Su, Cheuk Man Yu, B K S Sastry, Arun Gopi, K Raghu, C Sridevi, Daljeet Kaur, Keyur Parikh, Anish Chandarana, Urmil Shah, Milan Chag, Hemang Baxi, Satya Gupta, Jyoti Bhatia, Vaishali Khakhkhar, Vineet Sankhla, Tejas Patel, Vipul Kapoor, Rohit Tandon, Vijay Chopra, Manoj Kumar, Hatinder Jeet Singh Sethi, Rashmi Verma, Jitendra Sawhney, Manish Kr Sharma, Mohanan Padinhare Purayil, Muhammad Munawar, Jimmy Agung Pambudi, Antonia Lukito, Ingrid Pardede, Alvin Thengker, Vito Damay, Siska Suridanda Danny, Rarsari Surarso, Ryoubun Yasuoka, Kuniya Asai, Takanori Ikeda, Sang-Weon Park, Suk Keun Hong, SookJin Lee, Lim Dal Soo, Dong-Hyeok Kim, Jaemin Shim, Seong-Mi Park, Seung-Young Roh, Young Hoon Kim, Mina Kim, Jong-Il Choi, Jin Oh Na, Seung Woon Rha, Hong Seog Seo, Dong Joo Oh, Chang Gyu Park, Eung Ju Kim, Sunki Lee, Boyoung Joung, Jae-Sun Uhm, Moon Hyoung Lee, In-Jeong Cho, Hui-Nam Park, Hyung-Wook Park, Jeong-Gwan Cho, Namsik Yoon, KiHong Lee, Kye Hun Kim, Seong Hwan Kim, Houng Bang Liew, Sahrin Saharudin, Boon Cong Beh, Yu Wei Lee, Chia How Yen, Mohd Khairi Othman, Amie-Anne Augustine, Mohd Hariz Mohd Asnawi, Roberto Angelo Mojolou, You Zhuan Tan, Aida Nurbaini Arbain, Chii Koh Wong, Azmee Mohd Ghazi, Surinder Kaur Khelae, David S P Chew, Lok Bin Yap, Azlan Hussin, Zulkeflee Muhammad, Imran Zainal Abidin, Ahmad Syadi Bin Mahmood Zhudi, Nor Ashikin Md Sari, Ganiga Srinivasaiah Sridhar, Ahmad Syadi Mahmood Zuhdi, Muhammad Dzafir Ismail, Tiong Kiam Ong, Yee Ling Cham, Ning Zan Khiew, Asri Bin Said, Alan Yean Yip Fong, Nor Hanim Mohd Amin, Keong Chua Seng, Sian Kong Tan, Kuan Leong Yew, Eugenio Reyes, Jones Santos, Allan Lim, Raul Lapitan, Ryan Andal, Eleanor Lopez, Kheng Leng David Sim, Boon Yew Tan, Choon Pin Lim, Louis L Y Teo, Laura L H Chan, Ping Chai, Ching Chiew Raymond Wong, Kian Keong Poh, Poh Shuan Daniel Yeo, Evelyn M Lee, Seet Yong Loh, Min Er Ching, Deanna Z L Khoo, Min Sen Yew, Wenjie Huang, Jia Hao Jason See, Yaozong Benji Lim, Svenszeat Tan, Colin Yeo, Siang Chew Chai, Fazlur Rehman Jaufeerally, Haresh Tulsidas, Than Aung, Hean Yee Ong, Lee Fong Ling, Dinna Kar Nee Soon, Hung-I Yeh, Jen-Yuan Kuo, Chih-Hsuan Yen, Juey-Jen Hwang, Kuo-Liong Chien, Ta-Chen Su, Lian-Yu Lin, Jyh-Ming Juang, Yen-Hung Lin, Fu-Tien Chiang, Jiunn-Lee Lin, Yi-Lwun Ho, Chii-Ming Lee, Po-Chih Lin, Chi-Sheng Hung, Sheng-Nan Chang, Jou-Wei Lin, Chih-Neng Hsu, Wen-Chung Yu, Tze-Fan Chao, Shih-Hsien Sung, Kang-Ling Wang, Hsin-Bang Leu, Yenn-Jiang Lin, Shih-Lin Chang, Po-Hsun Huang, Li-Wei Lo, Cheng-Hsueh Wu, Hsin-Yueh Liang, Shih-Sheng Chang, Lien-Cheng Hsiao, Yu-Chen Wang, Chiung-Ray Lu, Hung-Pin Wu, Yen-Nien Lin, Ke-Wei Chen, Ping-Han Lo, Chung-Ho Hsu, Li-Chuan Hsieh, Mann Chandavimol, Teerapat Yingchoncharoen, Prasart Laothavorn, Wanwarang Wongcharoen, Arintaya Phrommintikul

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 rEF). 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: NCT01633398.

Keywords: epidemiology; heart failure; mortality.

Figures

Figure 1
Figure 1
One‐year mortality and cause of death by region and heart failure group. CV indicates cardiovascular; HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction.
Figure 2
Figure 2
Kaplan–Meier curves for mortality by region.
Figure 3
Figure 3
Kaplan–Meier curves for mortality by heart failure group. A, Heart failure with reduced ejection fraction (HFrEF). B, Heart failure with preserved ejection fraction (HFpEF).

References

    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez‐Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members . 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129–2200.
    1. Braunwald E. The war against heart failure: the Lancet lecture. Lancet. 2015;385:812–824.
    1. Cook C, Cole G, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure. Int J Cardiol. 2014;171:368–376.
    1. Conrad N, Judge A, Tran J, Mohseni H, Hedgecott D, Crespillo AP, Allison M, Hemingway H, Cleland JG, McMurray JJV, Rahimi K. Temporal trends and patterns in heart failure incidence: a population‐based study of 4 million individuals. Lancet. 2018;391:572–580.
    1. Lam CSP. Heart failure in Southeast Asia: facts and numbers. ESC Heart failure. 2015;2:46–49.
    1. Dokainish H, Teo K, Zhu J, Roy A, AlHabib KF, ElSayed A, Palileo‐Villaneuva L, Lopez‐Jaramillo P, Karaye K, Yusoff K, Orlandini A, Sliwa K, Mondo C, Lanas F, Prabhakaran D, Badr A, Elmaghawry M, Damasceno A, Tibazarwa K, Belley‐Cote E, Balasubramanian K, Islam S, Yacoub MH, Huffman MD, Harkness K, Grinvalds A, McKelvie R, Bangdiwala SI, Yusuf S; Inter‐CHF Investigators . Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER‐CHF) prospective cohort study. Lancet Glob Health. 2017;5:e665–e672.
    1. Reyes EB, Ha JW, Firdaus I, Ghazi AM, Phrommintikul A, Sim D, Vu QN, Siu CW, Yin WH, Cowie MR. Heart failure across Asia: same healthcare burden but differences in organization of care. Int J Cardiol. 2016;223:163–167.
    1. Mentz RJ, Roessig L, Greenberg BH, Sato N, Shinagawa K, Yeo D, Kwok BW, Reyes EB, Krum H, Pieske B, Greene SJ, Ambrosy AP, Kelly JP, Zannad F, Pitt B, Lam CS. Heart failure clinical trials in east and Southeast Asia: understanding the importance and defining the next steps. JACC Heart Fail. 2016;4:419–427.
    1. Lam CS, Teng TK, Tay WT, Anand I, Zhang S, Shimizu W, Narasimhan C, Park SW, Yu CM, Ngarmukos T, Omar R, Reyes EB, Siswanto BB, Hung CL, Ling LH, Yap J, MacDonald M, Richards AM. Regional and ethnic differences among patients with heart failure in Asia: the Asian sudden cardiac death in heart failure registry. Eur Heart J. 2016;37:3141–3153.
    1. MacDonald MR, Wee PP, Cao Y, Yang DM, Lee S, Tong KL, Leong KT. Comparison of characteristics and outcomes of heart failure patients with preserved versus reduced ejection fraction in a multiethnic Southeast Asian cohort. Am J Cardiol. 2016;118:1233–1238.
    1. Lam CS, Anand I, Zhang S, Shimizu W, Narasimhan C, Park SW, Yu CM, Ngarmukos T, Omar R, Reyes EB, Siswanto B, Ling LH, Richards AM. Asian Sudden Cardiac Death in Heart Failure (ASIAN‐HF) registry. Eur J Heart Fail. 2013;15:928–936.
    1. Ho KK, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol. 1983;22(4 Suppl A):6A–13A.
    1. Tromp J, Teng THK, Tay WT, Hung CL, Narasimhan C, Ngarmukos T, Reyes E, Siswanto B, Yu C, Zhang S, Yap J, MacDonald M, Leineweber K, Richards AM, Zile M, Anand I, Lam CSP. Heart failure with preserved ejection fraction in Asia. Eur J Heart Fail. 2019;21:23–36.
    1. Lang RM, Badano LP, Mor‐Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1–39.e14.
    1. Hicks KA, Mahaffey KW, Mehran R, Nissen SE, Wiviott SD, Dunn B, Solomon SD, Marler JR, Teerlink JR, Farb A, Morrow DA, Targum SL, Sila CA, Hai MTT, Jaff MR, Joffe HV, Cutlip DE, Desai AS, Lewis EF, Gibson CM, Landray MJ, Lincoff AM, White CJ, Brooks SS, Rosenfield K, Domanski MJ, Lansky AJ, McMurray JJV, Tcheng JE, Steinhubl SR, Burton P, Mauri L, O'Connor CM, Pfeffer MA, Hung HMJ, Stockbridge NL, Chaitman BR, Temple RJ; Standardized Data Collection for Cardiovascular Trials Initiative (SCTI) . 2017 cardiovascular and stroke endpoint definitions for clinical trials. Circulation. 2018;137:961–972.
    1. Heller G. A measure of explained risk in the proportional hazards model. Biostatistics. 2012;13:315–325.
    1. Koh AS, Tay WT, Teng THK, Vedin O, Benson L, Dahlstrom U, Savarese G, Lam CSP, Lund LH. A comprehensive population‐based characterization of heart failure with mid‐range ejection fraction. Eur J Heart Fail. 2017;19:1624–1634.
    1. Kristensen SL, Martinez F, Jhund PS, Arango JL, Belohlavek J, Boytsov S, Cabrera W, Gomez E, Hagege AA, Huang J, Kiatchoosakun S, Kim KS, Mendoza I, Senni M, Squire IB, Vinereanu D, Wong RC, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR, Packer M, McMurray JJ. Geographic variations in the PARADIGM‐HF heart failure trial. Eur Heart J. 2016;37:3167–3174.
    1. Chia YMF, Teng TK, Tan ESJ, Tay WT, Richards AM, Chin CWL, Shimizu W, Park SW, Hung CL, Ling LH, Ngarmukos T, Omar R, Siswanto BB, Narasimhan C, Reyes EB, Yu CM, Anand I, MacDonald MR, Yap J, Zhang S, Finkelstein EA, Lam CSP. Disparity between indications for and utilization of implantable cardioverter defibrillators in Asian patients with heart failure. Circ Cardiovasc Qual Outcomes. 2017;10:e003651.
    1. Greene SJ, Fonarow GC, Solomon SD, Subacius H, Maggioni AP, Bohm M, Lewis EF, Zannad F, Gheorghiade M; ASTRONAUT Investigators and Coordinators . Global variation in clinical profile, management, and post‐discharge outcomes among patients hospitalized for worsening chronic heart failure: findings from the ASTRONAUT trial. Eur J Heart Fail. 2015;17:591–600.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir