Differences in treatment, outcomes, and quality of life among patients with heart failure in Canada and the United States.


Journal Article

OBJECTIVES: The aim of this study was to compare clinical outcomes, resource utilization, and health-related quality of life between Canadian and U.S. patients enrolled in ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure). A further aim was to supplement the within-trial analysis with a contemporaneous population-based comparison of all patients hospitalized with primary diagnoses of heart failure (HF) in the 2 countries. BACKGROUND: Little is known about intercountry differences in outcomes of patients with HF in Canada and the United States. METHODS: Trial patients consisted of 465 Canadian and 2,684 U.S. patients enrolled in ASCEND-HF. Population-level cohorts consisted of 1.9 million U.S. and 81,016 Canadians hospitalized for HF in 2007 and 2008. RESULTS: Canadian patients in ASCEND-HF were older, were more likely to be white, and had lower body weights and blood pressures than U.S. patients. Canadians also had lower baseline-adjusted odds of 30-day mortality (odds ratio: 0.46; 95% confidence interval: 0.23 to 0.92) and better health-related quality of life than U.S. patients. In both countries, trial patients differed significantly from population-level cohorts. In contrast to ASCEND-HF, unadjusted in-hospital mortality at the population level was significantly lower in the United States (3.4%) compared with Canada (11.1%) (p < 0.01). CONCLUSIONS: Intercountry differences in outcomes of patients hospitalized with HF differed significantly between trial and population cohorts. Further study on how cardiac care is delivered in the 2 countries and how it influences the results of clinical trials and population-level outcomes, especially in the long term, is warranted. (A Study Testing the Effectiveness of Nesiritide in Patients With Acute Decompensated Heart Failure; NCT00475852).

Full Text

Duke Authors

Cited Authors

  • Kaul, P; Reed, SD; Hernandez, AF; Howlett, JG; Ezekowitz, JA; Li, Y; Zheng, Y; Rouleau, JL; Starling, RC; O'Connor, CM; Califf, RM; Armstrong, PW

Published Date

  • December 2013

Published In

Volume / Issue

  • 1 / 6

Start / End Page

  • 523 - 530

PubMed ID

  • 24622005

Pubmed Central ID

  • 24622005

Electronic International Standard Serial Number (EISSN)

  • 2213-1787

Digital Object Identifier (DOI)

  • 10.1016/j.jchf.2013.07.004


  • eng

Conference Location

  • United States