Abstract 13770: Geographic Variation in Clinical Course Among Patients Hospitalized for Acute Heart Failure: Insights From ASCEND-HF
Background. Clinical outcome trials in acute heart failure (AHF) generally require large numbers of patients and geographical differences in patient characteristics or other factors may influence trial results. ASCEND-HF is the largest trial in patients with AHF with 7141 patients enrolled from all major regions of the world, except Africa.
Methods. Geographic differences in patient characteristics and observed outcomes of the ASCEND-HF patients were examined by 5 major geographical areas (North America (NA), Latin America (LA), Central Europe (CE), Western Europe (WE), and Asia-Pacific (AP). Using the ASCEND-HF mortality and morbidity models, risk-adjusted outcomes were assessed at day 30 from randomization.
Results. Significant differences among different geographic areas were observed with respect to age, demographics, past medical history, and other clinical variables (P<0.01). Patients from Central and Western Europe had the longest duration of hospitalization and lowest rates of death or rehospitalization (Table). After adjustment for clinical characteristics (age, BUN, serum sodium, SBP, baseline dyspnea), the risk of 30-day mortality did not vary by region relative to North America (odds ratio [OR] [95% CI] AP=0.92 [0.65-1.28]; CE=0.88 [0.57-1.34]; LA=1.09 [0.74-1.61]; WE=0.81 [0.50-1.31]; P=0.78). However, risk of 30-day mortality/HF readmission adjusted for 12 baseline variables did vary by region compared with North America OR (95% CI): AP=0.46 (0.33-0.63; P<0.01); CE=0.75 (0.55-1.01; P=0.06); LA=0.51 (0.35-0.74; P<0.01); WE=0.97 (0.96-0.99; P<0.01).
Conclusion. Geographic differences exist in patient characteristics and outcomes for ADHF. Patients from North America have the highest rehospitalization rate and those in Europe have the longest lengths of stay. Further investigation is needed to understand differences in rates of rehospitalization including the influence of index hospital length of stay.
- © 2011 by American Heart Association, Inc.