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Intercountry Differences in Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure.

Publication ,  Journal Article
Fuery, MA; Chouairi, F; Januzzi, JL; Moe, GW; Caraballo, C; McCullough, M; Miller, PE; Reinhardt, SW; Clark, K; Oseran, A; Milner, A; Pacor, J ...
Published in: JACC Heart Fail
July 2021

OBJECTIVES: The aim of this study was to examine patterns of care and clinical outcomes among patients with heart failure with reduced ejection fraction (HFrEF) in the United States and Canada. BACKGROUND: In the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment) trial, the use of N-terminal pro-B-type natriuretic peptide-guided titration of guideline-directed medical therapy (GDMT) was compared with usual care alone for patients with HFrEF in the United States and Canada. It remains unknown whether the country of enrollment had an impact on outcomes or GDMT use. METHODS: A total of 894 patients at 45 sites across the United States and Canada with HFrEF (ejection fraction ≤40%) were enrolled in the trial. Kaplan-Meier survival estimates stratified by country of enrollment were developed for the trial outcomes, and log-rank testing was compared between the groups. GDMT use and titration were also compared. RESULTS: U.S. patients were more likely to be younger, to be Black, to have higher body mass index, and to have histories of defibrillator placement or sleep apnea. Use of β-blockers was significantly higher in Canada at baseline (99.3% vs. 94.0%; p = 0.01) and 6 months (99.0% vs. 94.1%; p = 0.04), and use of mineralocorticoid receptor antagonists was higher in Canada at 6 months (68.3% vs. 55.1%; p = 0.01). Canadian patients were less likely to experience the primary study endpoint (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.45 to 0.93; p = 0.01) due to decreased rates of HF hospitalization (HR: 0.57; 95% CI: 0.38 to 0.86; p = 0.003). The differences in outcomes were driven by increased heart failure hospitalization among U.S. Black patients. CONCLUSIONS: In GUIDE-IT, patients with HFrEF in Canada were significantly less likely to be hospitalized for heart failure. Differences in GDMT use, along with differences in sociodemographics and care delivery structures, may contribute to these differences, highlighting the importance of increasing diversity in clinical trials. (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment [GUIDE-IT]; NCT01685840).

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

July 2021

Volume

9

Issue

7

Start / End Page

497 / 505

Location

United States

Related Subject Headings

  • United States
  • Stroke Volume
  • Practice Guidelines as Topic
  • Mineralocorticoid Receptor Antagonists
  • Humans
  • Hospitalization
  • Heart Failure
  • Canada
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Fuery, M. A., Chouairi, F., Januzzi, J. L., Moe, G. W., Caraballo, C., McCullough, M., … Desai, N. R. (2021). Intercountry Differences in Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure. JACC Heart Fail, 9(7), 497–505. https://doi.org/10.1016/j.jchf.2021.02.011
Fuery, Michael A., Fouad Chouairi, James L. Januzzi, Gordon W. Moe, Cesar Caraballo, Megan McCullough, P Elliott Miller, et al. “Intercountry Differences in Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure.JACC Heart Fail 9, no. 7 (July 2021): 497–505. https://doi.org/10.1016/j.jchf.2021.02.011.
Fuery MA, Chouairi F, Januzzi JL, Moe GW, Caraballo C, McCullough M, et al. Intercountry Differences in Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure. JACC Heart Fail. 2021 Jul;9(7):497–505.
Fuery, Michael A., et al. “Intercountry Differences in Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure.JACC Heart Fail, vol. 9, no. 7, July 2021, pp. 497–505. Pubmed, doi:10.1016/j.jchf.2021.02.011.
Fuery MA, Chouairi F, Januzzi JL, Moe GW, Caraballo C, McCullough M, Miller PE, Reinhardt SW, Clark K, Oseran A, Milner A, Pacor J, Kahn PA, Singh A, Ravindra N, Guha A, Vadlamani L, Kulkarni NS, Fiuzat M, Felker GM, O’Connor CM, Ahmad T, Ezekowitz J, Desai NR. Intercountry Differences in Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure. JACC Heart Fail. 2021 Jul;9(7):497–505.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

July 2021

Volume

9

Issue

7

Start / End Page

497 / 505

Location

United States

Related Subject Headings

  • United States
  • Stroke Volume
  • Practice Guidelines as Topic
  • Mineralocorticoid Receptor Antagonists
  • Humans
  • Hospitalization
  • Heart Failure
  • Canada
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology