Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study

Hisham Dokainish(Population Health Research Institute), Koon Teo(Population Health Research Institute), Jun Zhu(Chinese Academy of Medical Sciences & Peking Union Medical College), Ambuj Roy(All India Institute of Medical Sciences), Khalid F. AlHabib(King Saud University), Ahmed ElSayed, Lia Palileo-Villaneuva(University of the Philippines Manila), Patricio López‐Jaramillo(Universidad De Santander), Kamilu M. Karaye(Aminu Kano Teaching Hospital), Khalid Yusoff(UCSI University), Andrés Orlandini(Instituto Cardiovascular de Rosario), Karen Sliwa(South African Medical Research Council), Charles Mondo(Mulago Hospital), Fernando Laņas(Universidad de La Frontera), Dorairaj Prabhakaran(Centre for Chronic Disease Control), Amr Badr(Hamad Medical Corporation), Mohamed ElMaghawry(Aswan University), Albertino Damasceno(Eduardo Mondlane University), Kemi Tibazarwa(Muhimbili National Hospital), Emilie P. Belley‐Côté(Population Health Research Institute), Kumar Balasubramanian(Population Health Research Institute), Shofiqul Islam(Population Health Research Institute), Magdi H. Yacoub(Hamad Medical Corporation), Mark D. Huffman(Northwestern University), Karen Harkness(Population Health Research Institute), Alex Grinvalds(Population Health Research Institute), Robert S. McKelvie(Population Health Research Institute), Shrikant I. Bangdiwala(Population Health Research Institute), Salim Yusuf(Population Health Research Institute), Ruy R. Campos(South African Medical Research Council), Cecilia Chacón(South African Medical Research Council), Guillermo Cursack(South African Medical Research Council), Fabián Diez(South African Medical Research Council), Carlos Escobar(South African Medical Research Council), Carlos García(South African Medical Research Council), Oscar Gómez Vilamajó, Miguel Hominal(Population Health Research Institute), Adrián Ingaramo, G. Kucharczuk(South African Medical Research Council), Mauricio Pelliza(Population Health Research Institute), Angela Rosa Guitiérrez Rojas, Alessandra Villani, Gerardo Zapata(South African Medical Research Council), Paula Bourke(Population Health Research Institute), Fernando Laņas(Universidad de La Frontera), L. Nahuelpan(Population Health Research Institute), Carlos Olivares(South African Medical Research Council), R. Riquelme(South African Medical Research Council), Fen Ai(Centre for Chronic Disease Control), Xiuyuan Bai(Population Health Research Institute), Xurui Chen(Population Health Research Institute), Y. Chen(Population Health Research Institute), Min Gao(Population Health Research Institute), Chenliang Ge(South African Medical Research Council), YANBIAO HE(Population Health Research Institute), Wenjie Huang(Population Health Research Institute), Hongqun Jiang(South African Medical Research Council), Tuo Liang(South African Medical Research Council), Xinling Liang(Population Health Research Institute), Yuhua Liao(Population Health Research Institute), S. Liu(South African Medical Research Council), Yu Luo(Population Health Research Institute), L. Lu(Aminu Kano Teaching Hospital), Shengmei Qin(South African Medical Research Council), Gabriel Tan(South African Medical Research Council), Hua Tan(South African Medical Research Council), T. Wang(South African Medical Research Council), Xuchen Wang(Population Health Research Institute), Fanchao Wei(South African Medical Research Council), Fei Xiao(South African Medical Research Council), B. Zhang(Population Health Research Institute), Tianheng Zheng(South African Medical Research Council), J.L. Mendoza, M. Blanquicett Anaya, Efraín Gómez(South African Medical Research Council), D.I. Molina de Salazar, Franklin Quiroz(South African Medical Research Council), M.J. Mota Rodríguez, M. Suarez Sotomayor, A. Torres Navas, M. Bravo León, Leilani Montalvo, Mónica Jaramillo(Universidad De Santander), Emilia Patiño, C Perugachi(South African Medical Research Council), F. Trujillo Cruz(South African Medical Research Council), Mohamed ElMaghawry(Aswan University), Kerolos Wagdy(Population Health Research Institute), Aishwarya Bhardwaj(Centre for Chronic Disease Control), Vivek Chaturvedi(South African Medical Research Council), G. Krishna Gokhale, Rajeev Gupta(South African Medical Research Council), R. Honnutagi(South African Medical Research Council), Parag H. Joshi(Population Health Research Institute), Shamez Ladhani(South African Medical Research Council), Prakash Chand Negi, Ambuj Roy(All India Institute of Medical Sciences), Naveen Reddy(South African Medical Research Council), Ahed Najimelddin Abdullah, Mustafa Hassan, M. Balasinga(Population Health Research Institute), Sazzli Kasim(South African Medical Research Council), Wenqin Tan, Khalid Yusoff(UCSI University), Albertino Damasceno(Eduardo Mondlane University), Reginaldo Banze(South African Medical Research Council), E. Calua(South African Medical Research Council), Cristina Novela(South African Medical Research Council), Jocelia Chemane(Centre for Chronic Disease Control), A.A. Akintunde, V. Ansa(South African Medical Research Council), H. Gbadamosi(South African Medical Research Council), Kamilu M. Karaye(Aminu Kano Teaching Hospital), Amam Mbakwem, Shafiu Mohammed(South African Medical Research Council), Chibuike Eze Nwafor(South African Medical Research Council), Dike Ojji(Population Health Research Institute), Taiwo Olunuga(South African Medical Research Council), B. Onwubere H. Sa'idu, Ejiroghene Martha Umuerri(South African Medical Research Council), Jennifer E. Reyes Alcaraz(Centre for Chronic Disease Control), Lia M. Palileo‐Villanueva(Population Health Research Institute), E. Palomares(South African Medical Research Council), M. Roxas Timonera, Amr Badr(Hamad Medical Corporation), Saleh Alghamdi(South African Medical Research Council), Khalid F. AlHabib(King Saud University), Ali Almasood, S. Alsaif(South African Medical Research Council), Abdelfatah Elasfar, Abdullah Ghabashi, Layth Mimish(Population Health Research Institute), Frederik Bester(South African Medical Research Council), D. Kelbe(Population Health Research Institute), E Klug(South African Medical Research Council), Karen Sliwa(South African Medical Research Council), K. Tibarzawa(Population Health Research Institute), O.E. Abdalla, Michela Dimitri(Aswan University), Hanif Muhammad Mustafa(South African Medical Research Council), Omnia Tajelsir Abdalla Osman(South African Medical Research Council), Ariel K. Saad, Charles Mondo(Mulago Hospital)
The Lancet Global Health
May 3, 2017
10.1016/s2214-109x(17)30196-1
Cited by 396Open Access
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Abstract

BACKGROUND: Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions. Here, in the International Congestive Heart Failure (INTER-CHF) study, we aimed to measure mortality at 1 year in patients with heart failure in Africa, China, India, the Middle East, southeast Asia and South America; we also explored demographic, clinical, and socioeconomic variables associated with mortality. METHODS: We enrolled consecutive patients with heart failure (3695 [66%] clinic outpatients, 2105 [34%] hospital in patients) from 108 centres in six geographical regions. We recorded baseline demographic and clinical characteristics and followed up patients at 6 months and 1 year from enrolment to record symptoms, medications, and outcomes. Time to death was studied with Cox proportional hazards models adjusted for demographic and clinical variables, medications, socioeconomic variables, and region. We used the explained risk statistic to calculate the relative contribution of each level of adjustment to the risk of death. FINDINGS: We enrolled 5823 patients within 1 year (with 98% follow-up). Overall mortality was 16·5%: highest in Africa (34%) and India (23%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the Middle East (9%). Regional differences persisted after multivariable adjustment. Independent predictors of mortality included cardiac variables (New York Heart Association Functional Class III or IV, previous admission for heart failure, and valve disease) and non-cardiac variables (body-mass index, chronic kidney disease, and chronic obstructive pulmonary disease). 46% of mortality risk was explained by multivariable modelling with these variables; however, the remainder was unexplained. INTERPRETATION: Marked regional differences in mortality in patients with heart failure persisted after multivariable adjustment for cardiac and non-cardiac factors. Therefore, variations in mortality between regions could be the result of health-care infrastructure, quality and access, or environmental and genetic factors. Further studies in large, global cohorts are needed. FUNDING: The study was supported by Novartis.

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