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

Publication ,  Journal Article
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 in: Jacc Heart Fail
December 2013

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).

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Published In

Jacc Heart Fail

DOI

EISSN

2213-1787

Publication Date

December 2013

Volume

1

Issue

6

Start / End Page

523 / 530

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Quality of Life
  • Natriuretic Peptide, Brain
  • Natriuretic Agents
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
  • Heart Failure
 

Citation

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Chicago
ICMJE
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Kaul, P., Reed, S. D., Hernandez, A. F., Howlett, J. G., Ezekowitz, J. A., Li, Y., … Armstrong, P. W. (2013). Differences in treatment, outcomes, and quality of life among patients with heart failure in Canada and the United States. Jacc Heart Fail, 1(6), 523–530. https://doi.org/10.1016/j.jchf.2013.07.004
Kaul, Padma, Shelby D. Reed, Adrian F. Hernandez, Jonathan G. Howlett, Justin A. Ezekowitz, Yanhong Li, Yinggan Zheng, et al. “Differences in treatment, outcomes, and quality of life among patients with heart failure in Canada and the United States.Jacc Heart Fail 1, no. 6 (December 2013): 523–30. https://doi.org/10.1016/j.jchf.2013.07.004.
Kaul P, Reed SD, Hernandez AF, Howlett JG, Ezekowitz JA, Li Y, et al. Differences in treatment, outcomes, and quality of life among patients with heart failure in Canada and the United States. Jacc Heart Fail. 2013 Dec;1(6):523–30.
Kaul, Padma, et al. “Differences in treatment, outcomes, and quality of life among patients with heart failure in Canada and the United States.Jacc Heart Fail, vol. 1, no. 6, Dec. 2013, pp. 523–30. Pubmed, doi:10.1016/j.jchf.2013.07.004.
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. Differences in treatment, outcomes, and quality of life among patients with heart failure in Canada and the United States. Jacc Heart Fail. 2013 Dec;1(6):523–530.
Journal cover image

Published In

Jacc Heart Fail

DOI

EISSN

2213-1787

Publication Date

December 2013

Volume

1

Issue

6

Start / End Page

523 / 530

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Quality of Life
  • Natriuretic Peptide, Brain
  • Natriuretic Agents
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
  • Heart Failure