Intercountry Differences in Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure

被引:7
作者
Fuery, Michael A. [1 ]
Chouairi, Fouad [2 ]
Januzzi, James L. [3 ]
Moe, Gordon W. [4 ]
Caraballo, Cesar [5 ,6 ]
McCullough, Megan [1 ]
Miller, P. Elliott [2 ]
Reinhardt, Samuel W. [2 ]
Clark, Katherine [2 ]
Oseran, Andrew [3 ]
Milner, Aidan [1 ]
Pacor, Justin [1 ]
Kahn, Peter A. [1 ]
Singh, Avinainder [1 ]
Ravindra, Neal [7 ]
Guha, Avirup [8 ]
Vadlamani, Lina [2 ]
Kulkarni, Neeti S. [9 ]
Fiuzat, Mona [10 ]
Felker, G. Michael [10 ]
O'Connor, Christopher M. [11 ]
Ahmad, Tariq [2 ,5 ,6 ]
Ezekowitz, Justin [12 ]
Desai, Nihar R. [2 ,5 ,6 ]
机构
[1] Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06510 USA
[2] Yale Univ, Sch Med, Sect Cardiovasc Med, New Haven, CT USA
[3] Harvard Med Sch, Div Cardiol, Dept Med, Boston, MA 02115 USA
[4] Univ Toronto, St Michaels Hosp, Toronto, ON, Canada
[5] Yale Univ, Ctr Outcomes Res & Evaluat, New Haven, CT USA
[6] Yale Univ, Sch Med, New Haven, CT USA
[7] Yale Sch Med, Cardiovasc Res Ctr, Sect Cardiovasc Med, Dept Internal Med, New Haven, CT USA
[8] Case Western Reserve Univ, Harrington Heart & Vasc Inst, Cleveland, OH 44106 USA
[9] Brandeis Univ, Waltham, MA USA
[10] Duke Univ, Duke Clin Res Inst, Durham, NC USA
[11] Inova Heart & Vasc Inst, Fairfax, VA USA
[12] Univ Alberta, Canadian VIGOUR Ctr, Edmonton, AB, Canada
基金
美国国家卫生研究院;
关键词
Canada; GUIDE-IT; guideline-directed medical therapy; heart failure and reduced ejection fraction; United States; 30-DAY READMISSION; FOLLOW-UP; RISK; MORTALITY; HOSPITALIZATION; ASSOCIATION; DISCHARGE; TRIALS;
D O I
10.1016/j.jchf.2021.02.011
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 examine patterns of care and clinical outcomes among patients with heart failure with reduced ejection fraction (HFrEF) in the United States and Canada. BACKGROUND In the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment) trial, the use of N-terminal pro-B-type natriuretic peptide-guided titration of guideline-directed medical therapy (GDMT) was compared with usual care alone for patients with HFrEF in the United States and Canada. It remains unknown whether the country of enrollment had an impact on outcomes or GDMT use. METHODS A total of 894 patients at 45 sites across the United States and Canada with HFrEF (ejection fraction <= 40%) were enrolled in the trial. Kaplan-Meier survival estimates stratified by country of enrollment were developed for the trial outcomes, and log-rank testing was compared between the groups. GDMT use and titration were also compared. RESULTS U.S. patients were more likely to be younger, to be Black, to have higher body mass index, and to have histories of defibrillator placement or sleep apnea. Use of beta-blockers was significantly higher in Canada at baseline (99.3% vs. 94.0%; p = 0.01) and 6 months (99.0% vs. 94.1%; p = 0.04), and use of mineralocorticoid receptor antagonists was higher in Canada at 6 months (68.3% vs. 55.1%; p = 0.01). Canadian patients were less likely to experience the primary study endpoint (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.45 to 0.93; p = 0.01) due to decreased rates of HF hospitalization (HR: 0.57; 95% CI: 0.38 to 0.86; p = 0.003). The differences in outcomes were driven by increased heart failure hospitalization among U.S. Black patients. CONCLUSIONS In GUIDE-IT, patients with HFrEF in Canada were significantly less likely to be hospitalized for heart failure. Differences in GDMT use, along with differences in sociodemographics and care delivery structures, may contribute to these differences, highlighting the importance of increasing diversity in clinical trials. (C) 2021 by the American College of Cardiology Foundation.
引用
收藏
页码:497 / 505
页数:9
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