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Global effort tracks causes, treatment of acute heart failure

Jan. 16, 2020, 11:20 AM


by Matt Batcheldor

Patients in North America wait a median of three hours to receive intravenous therapy for acute heart failure, while no other region in the world waited for more than 1.2 hours, according to a global study whose lead author and co-primary investigator is Sean Collins, MD, MSc, professor of Emergency Medicine.

“We are far ahead of the curve in North America for diagnostic testing and medications we can deliver,” Collins said. “We are perhaps a little bit behind in timeliness, though, because of our congested medical system.”

Sean Collins, MD, MSc, and colleagues are studying the characteristics, causes and management of patients presenting with acute heart failure. (photo by Joe Howell)

The study, recently published in JAMA Cardiology, is the first known prospective global research of acute heart failure patients at such a scale. More than 18,000 patients were enrolled at 358 sites in 44 countries and followed for two and a half years.

Collins, along with Vanderbilt University Medical Center’s Chris Lindsell, PhD, professor of Biostatistics, and biostatistician Kimberly Hart, MA, teamed up with institutions around the world to document the characteristics, causes and initial management of patients presenting with acute heart failure.

The study collected data worldwide about how quickly patients were treated, in-hospital mortality and length of stay across seven geographic regions, documenting major differences in treatment.

“We didn’t ask the physicians to collect any additional data outside of what they would do for normal care, but it gave us a great snapshot of what normal care really means,” Collins said. “From labs to treatment to length of stay in the hospital. That was the beauty of this prospective registry, to compare and contrast heart failure management across the globe over one period of time.”

Some other highlights of the study include:

  • Only 21% of patients in Southeast Asia had a prior history of heart failure before being diagnosed with acute heart failure. In other parts of the globe, 50% or more of patients had a pre-existing diagnosis.
  • Laboratory tests routinely ordered to treat patients in North America were not obtained in many parts of the world, likely due to costs, Collins added.
  • Patients in North America spent less time in the hospital for acute heart failure — four to five days versus other regions of the world, where patients stayed for a week or longer.

Collins said North American patients have shorter hospital stays likely due to an overburdened medical system, which increases pressure to discharge patients.

“I think it was really interesting to see how heart failure is managed significantly differently in many ways,” Collins said. “Patients arrive at the hospital via different methods throughout the world. Many places outside the U.S. deliver much of the care in the ambulance, so time to treatment is much shorter in parts of Europe compared to North America. Types of therapies are different. But also, the care leading up to that hospitalization is much different.”

Collins noted that the prospective cohort will continue to be followed for future studies, including quality of life, medication adherence and longer-term outcomes.

“We have longitudinal data that is actually quite reliable because it is obtained directly from the patient, resulting in minimal missing data due to having to rely on medical records,” he said. “We are just starting to gain momentum, but I suspect in the next year we will have three or four more impactful manuscripts.”

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