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H
eart failure mortality is inversely related to wealth of country
Death rates in patients with heart failure is inversely related to
the wealth of the country they live in, according to late breaking
results from the INTERCHF study, presented recently at Heart
Failure 2017 and the 4th World Congress on Acute Heart
Failure.Death rates in India and Africa were three to four times
higher than those documented in Western countries.
‘Heart failure is a common condition that causes morbidity
and mortality worldwide’, said lead author Dr Hisham
Dokainish, a principal investigator at the Population Health
Research Institute (PHRI), McMaster University, Hamilton,
Canada.
‘Most data on heart failure have come fromWestern countries
but the majority of the world’s population lives elsewhere’,
he continued. ‘This study was conducted to fill large gaps
in knowledge about congestive heart failure in non-Western
countries.’
The International Congestive Heart Failure (INTERCHF)
study was an observational cohort study that enrolled 5 823
patients with heart failure in 16 countries grouped into six
regions: Africa (Mozambique, Nigeria, South Africa, Sudan,
Uganda), China, India, the Middle East (Egypt, Qatar, Saudi
Arabia), south-east Asia (Malaysia, the Philippines), and South
America (Argentina, Chile, Colombia and Ecuador).
Data on each patient was collected at baseline, six months
and one year, and entered into the electronic data-management
system at PHRI. Baseline data included demographics (age,
gender), cardiac and non-cardiac factors (previous heart
attack or stroke, duration of congestive heart failure, diabetes
mellitus, renal failure, chronic obstructive pulmonary disease),
medications, socio-economic factors (education level, literacy,
employment, urban/rural setting) and heart failure aetiology.
At six months and one year, data were collected on the
frequency and cause of any hospitalisations in the previous six
months. Information was also recorded on death and cause of
death. The investigators calculated death rates in each region
and adjusted for 20 variables, which included demographic,
clinical, and socio-economic factors, medications and cause of
heart failure.
The overall all-cause mortality rate for the entire study
population was 17%. It was highest in Africa (34%) and India
(23%), intermediate in south-east Asia (15%), and lowest in the
Middle East (9%), South America (9%) and China (7%).
Dr Dokainish said: ‘Mortality in patients with heart failure
was inversely related to the wealth of the country. The poorer the
country, the higher the mortality rate, and the richer the country,
the lower the mortality rate.’
‘In Western countries the one-year mortality rate for patients
with heart failure is 5–10%’, added Dr Dokainish. ‘We’re finding
two to three times that death rate in African and Indian patients.’
‘We were very surprised by the much higher mortality rates’,
he continued. ‘You could say maybe the patients in Africa or
India were sicker, or didn’t take their medicines, or had poorer
heart function, but we adjusted for all of those things and don’t
really understand why their death rates were so much higher.’
The researchers hypothesised that variables not measured
in the study contributed to the high death rates, such as access
to and quality of healthcare, and cardiac biomarkers. These
variables will be measured in the next phase of the research
programme, the Global Congestive Heart Failure (G-CHF)
study, which aims to recruit 25 000 heart failure patients from
all inhabited continents and income levels. Genetic analyses will
also be conducted in a G-CHF sub-study.
Dr Dokainish said: ‘INTERCHF has shown that there are
large differences in the risk of heart failure patients dying at
one year depending on where they live. We hope to discover
why these differences exist through the G-CHF study. If that
identifies barriers to receiving care that are due to the way a
healthcare system is structured, access to healthcare, or quality
of healthcare, then that would need to be addressed.’
Source:
European Society of Cardiology Press Office