Global Variations in Heart Failure Etiology, Management, and Outcomes
Authors:   G-CHF Investigators, Rasmussen Mariela , Prado Aldo , Hominal Miguel A. , Zaidman Cesar J. , Cursack Guillermo , MacKinnon Ignacio , Zapata Gerardo , Rojas David G. , Duran Ruben G. , Vilamajo Oscar G. , Dutra Oscar P. , Oliveira Lívia , Pavanello Ricardo , Minelli César , Sousa Antonio , Maia Lilia N. , Hernandes Mauro E. , Oliveira Múcio , De Souza Weimar K. S. B. , Nobre Fernando , Clausell Nadine , Abib Eduardo , Bazan Silmeia Z. , Reis Gilmar , Clovis Nkoke , Tantchou Cabral , Abah Joseph P. , Kouam Charles K. , Tamdja Anastase D. , Manon Guillaume E. , Abang Serah M. , Feuzeu Stachys A. N. , Ban'Haka Herve M. , Nganou-Gnindjio Chris N. , Colette Sih , Nyanga Albert , Fomekong Tchinda G. , Ndjebet Jules , Ngongang Florent A. D. , Anderson Kim , Lepage Serge , Tournoux Francois , Racine Normand , Smith Stuart , McKelvie Robert , Moe Gordon , Zieroth Shelley , Toma Mustafa , Sia Ying T. , Heckman George , Ross Heather , Ezekowitz Justin , Senechal Mario , Swiggum Elizabeth , Vega Mario , Jano Gabriel , Bobadilla Braulio , Tan Huiqiong , Gou Jian W. , Jin Wei , Jiang Heng , Ai Fen , Zhou Wenxiu , Luo Hai Y. , Wei Fang , Jia Zhisheng , Peng Jie , Wang Xiuhong , Bai Xioajuan , Xu Jing , Liang Xue W. , Chen XiaoPing , Wang Tianxun , Zheng Tinlin , Qin Shaoming , Liang Tao , Tan Gange , Gao Xia , Chen Yunguo , Wu Jijin , Garcia Angel , Murillo Nelson , Ceron Juan A. , De Salazar Dora I. M. , Sandoval Jorge , Buitrago Andres , Eljach Julian E. V. , Mendoza Jose L. A. , Moreno Gustavo S. , Lozada Henry G. , Carreno Erika M. M. , Quiroz Franklin , Cadena Bonfanti Alberto , Buelvas Jannes , Dada Fredy A. T. , Sogaard Peter , Pedersen Maria , Gislason Gunnar , Nielsen Gitte , Wiggers Henrik , Jaramillo Milton S. , Anzules Nicholas , Duarte Yan C. , Long Freddy P. C. , Zuelta Iván , Velez Mayra S. , Lopez José , Trujillo Freddy , Carrasco Santiago , Gulec Sadi , Cavusoglu Yuksel , Acar Deniz R. , Yilmaz Mehmet B. , Celik Ahmet , Gosse Philippe , Kenizou David , Delarche Nicolas , Boulestreav Romain , Goussot Samuel , Hamou Kamel H. , Jourda Francois , Guillot Jean Paul , Tartiere Jean Michel , Schellong Sebastian , Mahrholdt Heiko , Jungmair Wolfgang , Kadel Christoph , Wolf Alexander , Bruder Oliver , Bott Michael C , Nagele Herbert , Hertting Klaus , Ito Wulf , Hintze Rene , Stahl Fabian , Maier Sebastian , Weiss Christian , Stoerk Thomas , Drexler Michael , Hagenow Andreas , Asotra Sanjeev , Chaudley Gaurav , Gupta Rajeev , Mohan Bishav , Jathappa Narendra , Varghese Kiron , Abdullakutty Jabir , Negi Parkash , Karna Sunil , Chandra Sharad , Russo Giulia , Cosmi Franco , D'Orazio Simona , Gulizia Michele , Moccetti Tiziano , Scopigni Francesca , Marcassa Claudio , Frisinghelli Anna , Villani Giovanni Q , Venturi Flavio , Piccinni Giancarlo , Piepoli Massimo , Nalwa Wafula , Mbugua Evelyn , Barasa Felix , Castro-Montes Eliodoro , Lopez Jose A. C. , Bhatta Yadav , Sharma Deewakar , Ansa Victor , Ogah Okechukwu , Saidu Hadiza , Kayani Azhar M. , Evangelista Lauren K. , Tirador Louie , Cruz Josefina , Morales Dante , Sulit Dennis , Bednarski Janusz , Czerski Tomasz , Skorski Marcin , Cymerman Krzysztof , Korol Marek , Miklaszewicz Beata , Piepiorka Marek , Wujkowski Marek , Mirek-Bryniarska Ewa , Owsiak Michal , Gniot Jacek , Stasiwski Arkadiusz , Solkiewicz Monika , Sudnik Wanda , Chmielinski Arkadiusz , Andrade Aurora , Moreira Ilidio , Isakova Svetlana , Ivan Shvedov , Kovalkova Natalia , Panov Dmitry , Salbieva Anzhela , Sergey Zabashta , Yufereva Yulia , Yusubova Anara , Poponina Tatiana , Gafarov Valery , Osipova Irina , Pozdnyakov Yury , Sizova Zhanna , Habeeb Waleed , Kassim Yasser , Monem Salwa , Zeyad Mohamed , Alasmari Sami , Alghalayini Kamal , Kinsara Abdulhalim , Ullah Jan Ubaid , Lawand Samih , Mphahlele Makgotsane J. , Moeketsi Khulile , Ntsekhe Mpiko , Ratsela Andrew , Thomas Baby M. , Caballero Eduardo B. , De La Espriella Rafael , Garrido Bravo Iris , Minan Gema , Paniagua Martin Maria J. , Perez Francisco , Roses Josep L. , Santiago Evelyn , Goloskokova Valentina , Thulin Jorgen , Thorvaldsen Tonje , Lindholm Carl-Johan , Floderer Nagy Z , Lönnberg Ingemar , Kanenda Said , Duma Neema , Meda John R. , Chillo Pilly , Vogt Rainer , Kalokola Fredrick , Kataraihya Johannes , Mwakalukwa Benson , Kisenge Peter , Cetin Hande E. O. , Lugero Charles , Voronkov Leonid , Fedorov Sergiy , Andriyevska Svitlana , Vereschuk Larysa , Zalizna Yulia , Jhund Pardeep , Barton John , Moriarty Andrew , Donnelly Patrick , Murphy Andrew , Edwards Tim , Arden Christopher , Fuat Ahmet , Witherow Fraser , Mcadam Brendan , Arimie Raluca , Adler Frederic , Maurice Kristen , Meier Mark A. , Mehta Rajendra , Kitchen Timothy , Malhotra Vinay , Whellan David , Piña Illeana , Murthy Sandhya , Kostis John , Gulati Martha , Gopalan Radha , Gaggin Hanna , Airhart Sophia , Juneman Elizabeth , Sweitzer Nancy , Thew Stephen , Joseph Philip , Roy Ambuj , Lonn Eva , Störk Stefan , Floras John , Mielniczuk Lisa , Rouleau Jean-Lucien , Zhu Jun , Dzudie Anastase , Balasubramanian Kumar , Karaye Kamilu , AlHabib Khalid F. , Gómez-Mesa Juan Esteban , Branch Kelley R. , Makubi Abel , Budaj Andrzej , Avezum Alvaro , Wittlinger Thomas , Ertl Georg , Mondo Charles , Pogosova Nana , Maggioni Aldo Pietro , Orlandini Andres , Parkhomenko Alexander , ElSayed Ahmed , López-Jaramillo Patricio , Grinvalds Alex , Temizhan Ahmet , Hage Camilla , Lund Lars H. , Kazmi Khawar , Lanas Fernando , Sharma Sanjib Kumar , Fox Keith , McMurray John J.V. , Leong Darryl , Dokainish Hisham , Khetan Aditya , Yonga Gerald , Kragholm Kristian , Wagdy Shaker Kerolos , Mwita Julius Chacha , Al-Mulla Arif Abdullatif , Alla François , Damasceno Albertino , Silva-Cardoso José , Dans Antonio L. , Sliwa Karen , O’Donnell Martin , Bazargani Nooshin , Bayés-Genís Antoni , McCready Tara , Probstfield Jeffrey , Yusuf Salim 
Published: May 2023

ImportanceMost epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries.ObjectiveTo examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development.Design, Setting, and ParticipantsMultinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years.Main Outcomes and MeasuresHF cause, HF medication use, hospitalization, and death.ResultsMean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P &amp;lt; .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies.Conclusions and RelevanceThis study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.