Differences in Treatment, Outcomes, and Quality of Life Among Patients With Heart Failure in Canada and the United States

被引：21

作者：

Kaul, Padma ^{[1
,2
]}

Reed, Shelby D. ^{[3
,4
]}

Hernandez, Adrian F. ^{[4
]}

Howlett, Jonathan G. ^{[5
]}

Ezekowitz, Justin A. ^{[1
,2
]}

Li, Yanhong ^{[3
,4
]}

Zheng, Yinggan ^{[1
,2
]}

Rouleau, Jean L. ^{[6
]}

Starling, Randall C. ^{[7
]}

O'Connor, Christopher M. ^{[4
]}

Califf, Robert M. ^{[8
]}

Armstrong, Paul W. ^{[1
,2
]}

机构：

[1] Univ Alberta, Dept Med, Div Cardiol, Edmonton, AB T6G 2E1, Canada

[2] Mazankowski Alberta Heart Inst, Edmonton, AB, Canada

[3] Duke Clin Res Inst, Ctr Clin & Genet Econ, Durham, NC USA

[4] Duke Clin Res Inst, Durham, NC USA

[5] Univ Calgary, Dept Med, Calgary, AB, Canada

[6] Montreal Heart Inst, Montreal, PQ H1T 1C8, Canada

[7] Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44106 USA

[8] Duke Univ, Sch Med, Duke Translat Med Inst, Durham, NC USA

来源：

JACC-HEART FAILURE | 2013年 / 1卷 / 06期

关键词：

Hospital stay; Mortality; Outcomes; Quality of life;

D O I：

10.1016/j.jchf.2013.07.004

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to compare clinical outcomes, resource utilization, and health-related quality of life between Canadian and U.S. patients enrolled in ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure). A further aim was to supplement the within-trial analysis with a contemporaneous population-based comparison of all patients hospitalized with primary diagnoses of heart failure (HF) in the 2 countries. Background Little is known about intercountry differences in outcomes of patients with HF in Canada and the United States. Methods Results Trial patients consisted of 465 Canadian and 2,684 U.S. patients enrolled in ASCEND-HF. Population-level cohorts consisted of 1.9 million U.S. and 81,016 Canadians hospitalized for HF in 2007 and 2008. Results Canadian patients in ASCEND-HF were older, were more likely to be white, and had lower body weights and blood pressures than U.S. patients. Canadians also had lower baseline-adjusted odds of 30-day mortality (odds ratio: 0.46; 95% confidence interval: 0.23 to 0.92) and better health-related quality of life than U.S. patients. In both countries, trial patients differed significantly from population-level cohorts. In contrast to ASCEND-HF, unadjusted in-hospital mortality at the population level was significantly lower in the United States (3.4%) compared with Canada (11.1%) (p < 0.01). Conclusions Intercountry differences in outcomes of patients hospitalized with HF differed significantly between trial and population cohorts. Further study on how cardiac care is delivered in the 2 countries and how it influences the results of clinical trials and population-level outcomes, especially in the long term, is warranted. (A Study Testing the Effectiveness of Nesiritide in Patients With Acute Decompensated Heart Failure; NCT004 75852) (1 Am Coll Cardiol HF 2013;1:523-30) 2013 by the American College of Cardiology Foundation

引用

页码：523 / 530

页数：8

共 16 条

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