Patients discharged from the hospital with acute heart failure have higher one-year mortality rates in regions with low income or greater income inequality, according to a new global study whose authors include Sean Collins, MD, MSc, professor of Emergency Medicine at Vanderbilt.
The study, recently published in The Lancet Global Health, is the first known prospective global research of one-year mortality rates in acute heart failure patients at such a scale. More than 18,000 patients were enrolled at 358 sites in 44 countries on six continents. The study grouped the patients into seven geographic regions for analysis.
Twenty percent of the global population studied died within one year. Patients from Eastern Europe had the lowest one-year mortality at 16%, while the highest mortality rates were found in the eastern Mediterranean, Africa and Latin America at 22%. North America had 21%.
The study suggests that regions of the globe where acute heart failure patients consistently receive medications after discharge — known as guideline-directed medical therapy — have better outcomes.
“We know that use of guideline-directed medical therapy — ace inhibitors, beta blockers and aldosterone antagonists — does improve outcomes,” Collins said. “That was not a surprise. The surprise was the implementation of those medications at hospital discharge based on region and country.”
Such drugs are relatively inexpensive, Collins said, but they may be out of financial reach for patients from countries with low-income or high-income inequality.
“It also may be another signal that just follow-up care in general is a problem — getting to see your doctor, having a doctor to see, transportation, all those issues are a problem,” he said. “I think that’s probably an overall reflection of post-discharge care.”
Guideline-directed medical therapy was especially crucial for patients with lower ejection fractions, a measurement of how much blood flows from the left ventricle with each heartbeat.
“That is where the stark differences in mortality were,” Collins said. “We looked at not just whether the patients received the medications, but if they received them when indicated — in patients with reduced ejection fraction where we know they significantly impact mortality.”
Collins noted that the prospective cohort will continue to be followed for future studies, including quality of life, medication adherence and evaluating different precipitants across the globe.