Heart failure with reduced ejection fraction: comparison of patient characteristics and clinical outcomes within Asia and between Asia, Europe and the Americas

Aims: Nearly 60% of the World’s population lives in Asia but little is known about the characteristics and outcomes of Asian patients with heart failure with reduced ejection fraction (HFrEF) compared to other areas of the world. Methods and Results: We pooled two, large, global trials, with similar design, in 13174 patients with HFrEF (patient distribution: China 833, India 1390, Japan 209, Korea 223, Philippines 223, Taiwan 199 and Thailand 95, Western Europe (WE) 3521, Eastern Europe 4758, North America (NA) 613 and 1110 in Latin America). Asian patients were younger (55.0 to 63.9 years) than in WE (67.9 years) and NA (66.6 years). Diuretics and devices were used less, and digoxin used more, in Asia. MRA use was higher in China (66.3%), the Philippines (64.1%) and Latin America (62.8%) compared to Europe and North America (range 32.8% to 49.6%). The rate of cardiovascular death/HF hospitalisation was higher in Asia (e.g. Taiwan 17.2, China 14.9 per 100-person years) than in WE (10.4) and the NA (12.8). However, the adjusted risk of cardiovascular death was higher in many Asian countries than in WE (except Japan) and the risk of HF hospitalisation was lower in India and in the Philippines than in WE, but significantly higher in China, Japan, and Taiwan. Conclusion: Patient characteristics and outcomes vary between Asia and other regions and between Asian countries. These variations may reflect several factors including, geography, climate and environment, diet and lifestyle, health care systems, genetics and socioeconomic influences.