Regional Variation of Mortality in Heart Failure With Reduced and Preserved Ejection Fraction Across Asia: Outcomes in the ASIAN‐HF Registry
Authors: MacDonald Michael R. , Tay Wan Ting , Teng Tiew‐Hwa Katherine , Anand Inder , Ling Lieng Hsi , Yap Jonathan , Tromp Jasper , Wander Gurpreet S. , Naik Ajay , Ngarmukos Tachapong , Siswanto Bambang B. , Hung Chung‐Lieh , Richards A. Mark , Lam Carolyn S. P. , Liew Houng Bang , Narasimhan Calambur , Park Sang Weon , Reyes Eugenio , Shimizu Wataru , Zhang Shu , Wu Liqun , Ling Tianyou , Li Xinli , Zhang Haifeng , Su Yangang , Yu Cheuk Man , Sastry B K S , Gopi Arun , Raghu K , Sridevi C , Kaur Daljeet , Parikh Keyur , Chandarana Anish , Shah Urmil , Chag Milan , Baxi Hemang , Gupta Satya , Bhatia Jyoti , Khakhkhar Vaishali , Sankhla Vineet , Patel Tejas , Kapoor Vipul , Tandon Rohit , Chopra Vijay , Kumar Manoj , Sethi Hatinder Jeet Singh , Verma Rashmi , Sawhney Jitendra , Sharma Manish Kr. , Purayil Mohanan Padinhare , Munawar Muhammad , Pambudi Jimmy Agung , Lukito Antonia , Pardede Ingrid , Thengker Alvin , Damay Vito , Danny Siska Suridanda , Surarso Rarsari , Yasuoka Ryoubun , Asai Kuniya , Ikeda Takanori , Park Sang‐Weon , Hong Suk Keun , Lee SookJin , Soo Lim Dal , Kim Dong‐Hyeok , Shim Jaemin , Park Seong‐Mi , Roh Seung‐Young , Kim Young Hoon , Kim Mina , Choi Jong‐Il , Na Jin Oh , Rha Seung Woon , Seo Hong Seog , Oh Dong Joo , Park Chang Gyu , Kim Eung Ju , Lee Sunki , Joung Boyoung , Uhm Jae‐Sun , Lee Moon Hyoung , Cho In‐Jeong , Park Hui‐Nam , Park Hyung‐Wook , Cho Jeong‐Gwan , Yoon Namsik , Lee KiHong , Kim Kye Hun , Kim Seong Hwan , Liew Houng Bang , Saharudin Sahrin , Beh Boon Cong , Lee Yu Wei , Yen Chia How , Othman Mohd Khairi , Augustine Amie‐Anne , Asnawi Mohd Hariz Mohd , Mojolou Roberto Angelo , Tan You Zhuan , Arbain Aida Nurbaini , Wong Chii Koh , Ghazi Azmee Mohd , Khelae Surinder Kaur , Chew David S.P. , Yap Lok Bin , Hussin Azlan , Muhammad Zulkeflee , Abidin Imran Zainal , Zhudi Ahmad Syadi Bin Mahmood , Sari Nor Ashikin Md , Sridhar Ganiga Srinivasaiah , Zuhdi Ahmad Syadi Mahmood , Ismail Muhammad Dzafir , Ong Tiong Kiam , Cham Yee Ling , Khiew Ning Zan , Said Asri Bin , Fong Alan Yean Yip , Amin Nor Hanim Mohd , Seng Keong Chua , Tan Sian Kong , Yew Kuan Leong , Reyes Eugenio , Santos Jones , Lim Allan , Lapitan Raul , Andal Ryan , Lopez Eleanor , Sim Kheng Leng David , Tan Boon Yew , Lim Choon Pin , Teo Louis L.Y. , Chan Laura L. H. , Chai Ping , Wong Ching Chiew Raymond , Poh Kian Keong , Yeo Poh Shuan Daniel , Lee Evelyn M. , Loh Seet Yong , Ching Min Er , Khoo Deanna Z.L. , Yew Min Sen , Huang Wenjie , See Jia Hao Jason , Lim Yaozong Benji , Tan Svenszeat , Yeo Colin , Chai Siang Chew , Jaufeerally Fazlur Rehman , Tulsidas Haresh , Aung Than , Ong Hean Yee , Ling Lee Fong , Soon Dinna Kar Nee , Yeh Hung‐I , Kuo Jen‐Yuan , Yen Chih‐Hsuan , Hwang Juey‐Jen , Chien Kuo‐Liong , Su Ta‐Chen , Lin Lian‐Yu , Juang Jyh‐Ming , Lin Yen‐Hung , Chiang Fu‐Tien , Lin Jiunn‐Lee , Ho Yi‐Lwun , Lee Chii‐Ming , Lin Po‐Chih , Hung Chi‐Sheng , Chang Sheng‐Nan , Lin Jou‐Wei , Hsu Chih‐Neng , Yu Wen‐Chung , Chao Tze‐Fan , Sung Shih‐Hsien , Wang Kang‐Ling , Leu Hsin‐Bang , Lin Yenn‐Jiang , Chang Shih‐Lin , Huang Po‐Hsun , Lo Li‐Wei , Wu Cheng‐Hsueh , Liang Hsin‐Yueh , Chang Shih‐Sheng , Hsiao Lien‐Cheng , Wang Yu‐Chen , Lu Chiung‐Ray , Wu Hung‐Pin , Lin Yen‐Nien , Chen Ke‐Wei , Lo Ping‐Han , Hsu Chung‐Ho , Hsieh Li‐Chuan , Chandavimol Mann , Yingchoncharoen Teerapat , Laothavorn Prasart , Wongcharoen Wanwarang , Phrommintikul Arintaya 
Published: December 2019

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 r
EF
). 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:
NCT
01633398.