Regional Variation of Mortality in Heart Failure With Reduced and Preserved Ejection Fraction Across Asia: Outcomes in the ASIAN-HF Registry.

Michael R Macdonald,Ping Chai,Imran Zainal Abidin,Jia Hao Jason See,Azmee Mohd Ghazi,Min Er Ching,Suk Keun Hong,Li‐Chuan Hsieh,Yenn‐Jiang Lin,Kuo‐Liong Chien,Shih‐Hsien Sung,Shih‐Lin Chang,Hung‐Pin Wu,Prasart Laothavorn,Rohit Tandon,Sang‐Weon Park,Sheng‐Nan Chang,Aida Nurbaini Arbain,Kye Hun Kim,Boyoung Joung,Lian‐Yu Lin,Roberto Angelo Mojolou,Vijay Chopra,Svenszeat Tan,Jasper Tromp,Juey‐Jen Hwang,Arun Gopi,Yaozong Benji Lim,Eleanor Lopez,Rarsari Surarso,Chung‐Ho Hsu,Ke‐Wei Chen,Raul Lapitan,Namsik Yoon,Sookjin Lee,Vito Damay,Nor Hanim Mohd Amin,Chih‐Neng Hsu,Azlan Hussin,Chii Koh Wong,Hean Yee Ong,Boon Yew Tan,Chung‐Lieh Hung,Arintaya Phrommintikul,Shih‐Sheng Chang,Dong‐Hyeok Kim,Wataru Shimizu,Teerapat Yingchoncharoen,Surinder Kaur Khelae,Boon Cong Beh,Milan Chag,Chih‐Hsuan Yen,Jyoti Bhatia,Chia How Yen,Nor Ashikin Md Sari,Evelyn M Lee,Liqun Wu,Hsin‐Bang Leu,Young Hoon Kim,Wanwarang Wongcharoen,Siang Chew Chai,Yu Wei Lee,Chii‐Ming Lee,Seung Woon Rha,Ryoubun Yasuoka,Jiunn‐Lee Lin,Shu Zhang,Chang Gyu Park,Colin Yeo,Jin Oh Na,Vaishali Khakhkhar,Mina Kim,Chiung‐Ray Lu,Anish Chandarana,Cheng‐Hsueh Wu,Li‐Wei Lo,Daljeet Kaur,Sian Kong Tan,Mann Chandavimol,Muhammad Munawar,In‐Jeong Cho,Hemang Baxi,Keong Chua Seng,Choon Pin Lim,Tachapong Ngarmukos,Ching Chiew Raymond Wong,Vipul Kapoor,Wen‐Chung Yu,Seung‐Young Roh,Satya Gupta,Jen‐Yuan Kuo,Jong‐Il Choi,Sang Weon Park,Yen‐Nien Lin,Inder Anand,Jaemin Shim,Ajay Naik,Seong‐Mi Park,Zulkeflee Muhammad,Yangang Su,Fu‐Tien Chiang,Seong Hwan Kim,Kian Keong Poh,Moon Hyoung Lee,Mohd Khairi Othman,Hui‐Nam Park,Chi‐Sheng Hung,Po‐Hsun Huang,Mohd Hariz Mohd Asnawi,Tejas Patel,Mohanan Padinhare Purayil,Ahmad Syadi Bin Mahmood Zhudi,Siska Suridanda Danny,Poh Shuan Daniel Yeo,Hsin‐Yueh Liang,Muhammad Dzafir Ismail,Hong Seog Seo,Yi‐Lwun Ho,You Zhuan Tan,Jou‐Wei Lin,Houng Bang Liew,Yen‐Hung Lin,Haifeng Zhang,Kuniya Asai,Ryan Andal,Keyur Parikh,Min Sen Yew,Po‐Chih Lin,Tze‐Fan Chao,Tiong Kiam Ong,Vineet Sankhla,Seet Yong Loh,Alan Yean Yip Fong,Calambur Narasimhan,A Mark Richards,Dong Joo Oh,Tianyou Ling,Urmil Shah,Wan Ting Tay,Rashmi Verma,Ganiga Srinivasaiah Sridhar,Hatinder Jeet Singh Sethi,Kuan Leong Yew,Takanori Ikeda,Kheng Leng David Sim,Ta‐Chen Su,Lee Fong Ling,Lim Dal Soo,Jonathan Yap,Cheuk Man Yu,Jeong‐Gwan Cho,Lien‐Cheng Hsiao,Yu‐Chen Wang,Wenjie Huang,Tiew‐Hwa Katherine Teng,Sunki Lee,Lieng Hsi Ling,Ahmad Syadi Mahmood Zuhdi,Hung‐I Yeh,Eung Ju Kim,Xinli Li,Haresh Tulsidas,Ki-Hong Lee ,Hyungwook Park ,Eugenio B Reyes ,Than Htike Aung ,Laura Chan ,N.z Khiew ,J.p.s Sawhney ,Jyh‐Ming Jimmy Juang ,L B Yap ,P Lo ,Allan Ε Κ Lim ,Bambang Budi Siswanto ,A Said ,D.s.p Chew ,Dinna Soon ,Jae Sun Uhm ,Fazlur Jaufeerally ,Louis Teo ,Antonia Anna Lukito ,Chinta Siva Koti Rupa Sridevi ,Deanna Khoo ,M Kumar ,B.k.s Sastry ,S Saharudin ,Kozhiparambil Gopalan Raghu ,Y.l Cham ,J Ferreira Dos Santos ,Carolyn S.p Lam ,Manish Sharma ,A Thengker ,Gurpreet Singh Wander ,A.a Augustine ,Kangling Wang ,Jimmy Pambudi ,Ingrid Maria Pardede

doi:10.1161/jaha.119.012199

Abstract

BackgroundData 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; <40%) versus preserved EF (≥50%).Methods and ResultsThe ASIAN‐HF registry is a prospective longitudinal study. Participants with symptomatic HF were recruited from 46 secondary care centers in 3 Asian regions: South Asia (India), Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore), and Northeast Asia (South Korea, Japan, Taiwan, Hong Kong, China). Overall, 6480 patients aged >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.ConclusionsThis 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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