Socioeconomic Status and Outcomes in Heart Failure With Reduced Ejection Fraction From Asia
Authors: Teng Tiew-Hwa K. , Tay Wan Ting , Richards Arthur Mark , Chew Timothy Shi Ming , Anand Inder , Ouwerkerk Wouter , Chandramouli Chanchal , Huang Weiting , Lawson Claire A. , Kadam Umesh T. , Yap Jonathan , Lim Shirlynn , Hung Chung-Lieh , MacDonald Michael Ross , Loh Seet Yoong , Shimizu Wataru , Tromp Jasper , Lam Carolyn Su Ping , Ling Lieng Hsi , Liew Houng Bang , Narasimhan Calambur , Ngarmukos Tachapong , Park Sang Weon , Reyes Eugenio , Siswanto Bambang B. , Zhang Shu , Zhang Shu , Fan Xiaohan , Chen Keping , Wu Liqun , Xie Yucai , Jin Qi , Ling Tianyou , Li Xinli , Zhou Fang , Zhou Yanli , Xu Dongjie , Zhang Haifeng , Su Yangang , Chen Xueying , Qin Shengmei , Wang Jingfeng , Gong Xue , Wu Zhaodi , Yu Cheuk Man , Narasimhan Calambur , Sastry B K S , Gopi Arun , Raghu K , Sridevi C , Kaur Daljeet , Naik Ajay , Parikh Keyur , Chandarana Anish , Shah Urmil , Chag Milan , Baxi Hemang , Gupta Satya , Bhatia Jyoti , Khakhkhar Vaishali , Sankhla Vineet , Patel Tejas , Kapoor Vipul , Wander Gurpreet Singh , Tandon Rohit , Chopra Vijay , Kumar Manoj , Singh Sethi Hatinder Jeet , Verma Rashmi , Mittal Sanjay , Sawhney Jitendra , Sharma Manish Kr. , Purayil Mohanan Padinhare , Siswanto Bambang Budi , Sadikin RS Dr Hasan , Tedjokusumo Pintoko , Martanto Erwan , Munawar Muhammad , Pambudi Jimmy Agung , Karawaci RS Siloam , Lukito Antonia , Pardede Ingrid , Thengker Alvin , Damay Vito , Danny Siska Suridanda , Surarso Rarsari , Noda Takashi , Nakajima Ikutaro , Wada Mitsuru , Ishibashi Kohei , Kurita Takashi , Yasuoka Ryoubun , Asai Kuniya , Murai Kohji , Kubota Yoshiaki , Izumi Yuki , Ikeda Takanori , Hisatake Shinji , Kabuki Takayuki , Kiuchi Shunsuke , Hagiwara Nobuhisa , Suzuki Atsushi , Suzuki Dr Tsuyoshi , 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 , Mohd Asnawi Mohd Hariz , Mojolou Roberto Angelo , Tan You Zhuan , Arbain Aida Nurbaini , Wong Chii Koh , Omar Razali , Ghazi Azmee Mohd , Khelae Surinder Kaur , Chew David S.P. , Yap Lok Bin , Hussin Azlan , Muhammad Zulkeflee , Azmee Mohd. Ghazi , Abidin Imran Zainal , Mahmood Zhudi Ahmad Syadi Bin , Md Sari Nor Ashikin , Sridhar Ganiga Srinivasaiah , Mahmood Zuhdi Ahmad Syadi , Ismail Muhammad Dzafir , Ong Tiong Kiam , Cham Yee Ling , Khiew Ning Zan , Said Asri Bin , Yip Fong Alan Yean , Mohd Amin Nor Hanim , Seng Keong Chua , Tan Sian Kong , Yew Kuan Leong , Reyes Eugenio , Santos Jones , Lim Allan , Lapitan Raul , Andal Ryan , Lopez Eleanor , David Sim Kheng Leng , Tan Boon Yew , Lim Choon Pin , Teo Louis L.Y. , Chan Laura L.H. , Ling Lieng Hsi , Chai Ping , Raymond Wong Ching Chiew , Poh Kian Keong , Daniel Yeo Poh Shuan , Lee Evelyn M. , Ching Min Er , Khoo Deanna Z.L. , Yew Min Sen , Huang Wenjie , Gerard Leong Kui Toh , Jason See Jia Hao , 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 , Ngarmukos Tachapong , Chandavimol Mann , Yingchoncharoen Teerapat , Laothavorn Prasart , Tiyanon Waraporn , Wongcharoen Wanwarang , Phrommintikul Arintaya 
Published: March 2021

Background:
Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia.

Methods:
We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure).

Results:

Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (<US$1000); and 29.5% had no/only primary education. The largest disparity in treatment across regional income levels pertained to β-blocker and device therapies, with patients from low-income regions being less likely to receive these treatments compared with those from high-income regions and even greater disparity among patients with lower education status and lower household income within each regional income strata. Higher country- and patient-level socioeconomic indicators related to higher quality of life scores and lower risk of the primary composite outcome. Notably, we found a significant interaction between regional income level and both household income and education status (
P
interaction
<0.001 for both), where the association of low household income and low education status with poor outcomes was more pronounced in high-income compared with lower income regions.

Conclusions:
These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions.

Registration:

URL:
https://clinicaltrials.gov
; Unique Identifier: NCT01633398.