Triggers and treatment approaches to acute heart failure differ worldwide

The first analysis of data from the International REPORT-HF show that triggers of acute heart failure and treatment approaches differ in different geographical regions of the world as also the drugs used as treatment.

While, ischemia/acute coronary syndrome (ACS)/infarction constituted 25.6% of cases of HF in the Southeast Asian region, nonadherence to diet and medications (19.2%) were the main cause in North America.

l In Southeast Asia, the other factors causing HF (in descending order) were nonadherence to diet and medications (5.4%), uncontrolled hypertension (5.2%), arrhythmia (4.7%) followed by pneumonia/respiratory process/infection (4.5%).

l Uncontrolled hypertension (8.2%), arrhythmia (7.6%), ischemia/ACS/infarction (3.5%) and pneumonia/respiratory process/infection (4.1%) were found to be the other triggers for HF in North America.

Treatment approaches also found to vary among the different regions globally.

l Inotropes were used more often in Southeast Asia Western Pacific, and Eastern Europe (11.3–13.5%) compared to other regions viz. Western Europe and North America (3.1–4.3%).

l The time between contacting medical services and receiving intravenous diuretics was 3.5 hours (average) in North American vs just over one hour in other regions. While, treatment with IV vasodilators within 6 hours of hospital contact was associated with a significantly shorter length of hospitalization across all regions, factors like renal function, systolic BP, signs of congestion on chest X-ray and cause of acute HF also influenced duration of hospital stay.

These results from the REPORT-HF registry were presented at the ongoing Heart Failure 2018 and the World Congress on Acute Heart Failure in Vienna, Austria.

Unlike other registries, the REPORT-HF (REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure) is a dedicated HF global registry and collates data collected from patients in different regions of the world. The data compares regional differences in causes of acute heart failure, therapies, time to treatment and treatment outcomes in order to better understand the epidemiology of HF worldwide.

The Registry included 18,805 patients hospitalized with new‐onset (first diagnosis) heart failure (HF) or decompensation of chronic HF from 44 countries across seven regions: 1,622 patients in North America, 2,686 patients in Central and South America, 2,810 patients in Eastern Europe, 3,661 patients in Western Europe, 2,265 in the Eastern Mediterranean and Africa, 2,369 in Southeast Asia and 3,392 in the Western Pacific.

The median age of patients was 67 years, 52% were Caucasian, 31% were Asian, 5% were Black, and 61% were men.

(Source: ESC, May 26, 2018)

Dr KK Aggarwal

Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA