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Global variation in clinical profile, management, and post-discharge outcomes among patients hospitalized for worsening chronic heart failure: findings from the ASTRONAUT trial.

Publication ,  Journal Article
Greene, SJ; Fonarow, GC; Solomon, SD; Subacius, H; Maggioni, AP; Böhm, M; Lewis, EF; Zannad, F; Gheorghiade, M ...
Published in: Eur J Heart Fail
June 2015

AIMS: This study sought to investigate regional variation in clinical characteristics, therapy utilization, and post-discharge outcomes among patients hospitalized for heart failure (HHF) enrolled in the multinational ASTRONAUT (Aliskiren Trial on Acute Heart Failure Outcomes) trial. METHODS AND RESULTS: The ASTRONAUT trial randomized 1615 HHF patients with ejection fraction ≤40% to aliskiren or placebo. Enrolled patients were from Eastern Europe (n = 495, 30.7%), Asia/Pacific (n = 439, 27.2%), Western Europe (n = 395, 24.5%), Latin America (n = 163, 10.1%), and North America (n = 123, 7.6%). Marked differences were seen across geographic regions in terms of baseline demographics, vital signs, laboratory tests, co-morbidity burden, and use of guideline-recommended therapies. All-cause death at 12 months ranged from 7.3% in North America to 26.7% in Asia/Pacific, with differences largely driven by sudden cardiac death. Rates of repeat HHF at 12 months ranged from 22.7% in Latin America to 43.9% in North America. After adjustment for patient characteristics, region was an independent predictor of death at 12 months, with highest risk in Asia/Pacific (hazard ratio 3.04, 95% confidence interval 1.47-6.29, compared with North America) and lowest risk in North America and Western Europe. There was no association between region and the composite of cardiovascular mortality or HHF. CONCLUSION: For patients enrolled in this HHF trial, baseline characteristics and risk of death differed markedly by geographic region. Rates of death and repeat HHF demonstrated a general inverse relationship. Global differences in patient characteristics and outcomes should be accounted for when designing future HHF clinical trials.

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Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

June 2015

Volume

17

Issue

6

Start / End Page

591 / 600

Location

England

Related Subject Headings

  • Prospective Studies
  • Patient Discharge
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Global Health
  • Geography
  • Female
 

Citation

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Greene, S. J., Fonarow, G. C., Solomon, S. D., Subacius, H., Maggioni, A. P., Böhm, M., … ASTRONAUT Investigators and Coordinators, . (2015). Global variation in clinical profile, management, and post-discharge outcomes among patients hospitalized for worsening chronic heart failure: findings from the ASTRONAUT trial. Eur J Heart Fail, 17(6), 591–600. https://doi.org/10.1002/ejhf.280
Greene, Stephen J., Gregg C. Fonarow, Scott D. Solomon, Haris Subacius, Aldo P. Maggioni, Michael Böhm, Eldrin F. Lewis, Faiez Zannad, Mihai Gheorghiade, and Mihai ASTRONAUT Investigators and Coordinators. “Global variation in clinical profile, management, and post-discharge outcomes among patients hospitalized for worsening chronic heart failure: findings from the ASTRONAUT trial.Eur J Heart Fail 17, no. 6 (June 2015): 591–600. https://doi.org/10.1002/ejhf.280.
Greene SJ, Fonarow GC, Solomon SD, Subacius H, Maggioni AP, Böhm M, et al. Global variation in clinical profile, management, and post-discharge outcomes among patients hospitalized for worsening chronic heart failure: findings from the ASTRONAUT trial. Eur J Heart Fail. 2015 Jun;17(6):591–600.
Greene, Stephen J., et al. “Global variation in clinical profile, management, and post-discharge outcomes among patients hospitalized for worsening chronic heart failure: findings from the ASTRONAUT trial.Eur J Heart Fail, vol. 17, no. 6, June 2015, pp. 591–600. Pubmed, doi:10.1002/ejhf.280.
Greene SJ, Fonarow GC, Solomon SD, Subacius H, Maggioni AP, Böhm M, Lewis EF, Zannad F, Gheorghiade M, ASTRONAUT Investigators and Coordinators. Global variation in clinical profile, management, and post-discharge outcomes among patients hospitalized for worsening chronic heart failure: findings from the ASTRONAUT trial. Eur J Heart Fail. 2015 Jun;17(6):591–600.
Journal cover image

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

June 2015

Volume

17

Issue

6

Start / End Page

591 / 600

Location

England

Related Subject Headings

  • Prospective Studies
  • Patient Discharge
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Global Health
  • Geography
  • Female