Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Jan 2020)

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

DOI
https://doi.org/10.1161/JAHA.119.012199
Journal volume & issue
Vol. 9, no. 1

Abstract

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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; 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.

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