Abstract 14844: Regional Variations on Cardiovascular Outcomes in Stable Chronic Heart Failure Outpatients at Risk of or With Atherothrombosis - Insights From REACH Registry
Background: There is a growing recognition of geographic variation for clinical trial outcomes in patients with chronic HF. This study sought to investigate regional variation among patients with a history of HF in a registry population with or at risk for atherothrombosis.
Methods: 4 year CV outcomes of chronic HF patients (n=8,962) in Reduction of Atherothrombosis for Continued Health (REACH) Registry, an international, prospective cohort of stable outpatients with established ischemic events (CAD, CVD, and/or PAD) or multiple risk factors for atherothrombosis, were analyzed by geographic regions (North America (NA), Western Europe (WE), Eastern Europe (EE), Latin America (LA), Middle East (ME), and Asia Pacific (AP)).
Results: Among 68,236 patients enrolled, 18.1% (n=1,311) of EE patients, 15.0% (n=4,158) of NA patients, 13.9% (n=118) of ME patients, 13.1% (n=2,161) of WE patients, 7.8% (n=150) of LA patients, and 7.6% (n=1,064) of AP patients had a history of HF at baseline. The prevalence of traditional cardiovascular risk factors and the use of medical therapies varied significantly among regions. At 4 year, the rate of CV death, MI, stroke, or hospitalization for HF ranged from 27.1% in AP to 53.4% in ME (p<0.001). Similarly, a significant regional disparity was observed in recurrent HF hospitalization and CV death, however, with a different pattern for CV death (p<0.001 for both, fig.). These differences among regions persisted after adjustment for regional differences in key prognostic variables.
Conclusions: This large long term international database demonstrated regional heterogeneity in CV event rates, including hospitalization for heart failure, in patients with or at risk for atherothrombosis and a reported history of heart failure. These findings may have implications for estimating event rates and planning clinical trials of patients with heart failure.
Author Disclosures: E. Toda Kato: None. P. Steg: Honoraria; Modest; amarin, Bayer, Boehringer-Ingelheim, BMS, Daiichi-Sankyo, GSK, Lilly, Regeneron, CSL Behring, The Medicines Company, Novartis, Janssen, Pfizer, MSD, Lilly. Ownership Interest; Modest; Aterovax. Research Grant; Significant; sanofi, servier. Honoraria; Significant; AstraZeneca, Servier. S. Goto: Research Grant; Significant; RIKEN, JSPS, Sanofi. Honoraria; Significant; Bayer, Sanofi, AstraZeneca. J. Guo: None. K. Im: None. E. Gaxiola: None. E. Ohman: Research Grant; Modest; Daiichi sankyo, Eli Lilly & Company, Gilead Sciences. Consultant/Advisory Board; Modest; AstraZeneca, Daiichi Sankyo, Eli Lilly & Company, Gilead Sciences, Pozen, Inc, The Medicines Company. Consultant/Advisory Board; Significant; Abiomed, Janssen, Sanofi Aventis, WebMD. K. Eagle: Research Grant; Modest; Gore PharmBIO Products, Medtronic. D.L. Bhatt: Research Grant; Significant; Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, The Medicines Company, Forest Laboratories, Ischemix, Pfizer, Roche.
- © 2015 by American Heart Association, Inc.