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International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS.

Publication ,  Journal Article
Bhatt, AS; Luo, N; Solomon, N; Pagidipati, NJ; Ambrosio, G; Green, JB; McGuire, DK; Standl, E; Cornel, JH; Halvorsen, S; Lopes, RD; White, HD ...
Published in: Am Heart J
December 2019

International differences in management/outcomes among patients with type 2 diabetes and heart failure (HF) are not well characterized. We sought to evaluate geographic variation in treatment and outcomes among these patients. METHODS AND RESULTS: Among 14,671 participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), those with HF at baseline and a documented ejection fraction (EF) (N = 1591; 10.8%) were categorized by enrollment region (North America, Latin America, Western Europe, Eastern Europe, and Asia Pacific). Cox models were used to examine the association between geographic region and the primary outcome of all-cause mortality (ACM) or hospitalization for HF (hHF) in addition to ACM alone. Analyses were stratified by those with EF <40% or EF ≥40%. The majority of participants with HF were enrolled in Eastern Europe (53%). Overall, 1,267 (79.6%) had EF ≥40%. β-Blocker (83%) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (86%) use was high across all regions in patients with EF <40%. During a median follow-up of 2.9 years, Eastern European participants had lower rates of ACM/hHF compared with North Americans (adjusted hazard ratio: 0.45; 95% CI: 0.32-0.64). These differences were seen only in the EF ≥40% subgroup and not the EF <40% subgroup. ACM was similar among Eastern European and North American participants (adjusted hazard ratio: 0.79; 95% CI: 0.44-1.45). CONCLUSIONS: Significant variation exists in the clinical features and outcomes of HF patients across regions in TECOS. Patients from Eastern Europe had lower risk-adjusted ACM/hHF than those in North America, driven by those with EF ≥40%. These data may inform the design of future international trials.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2019

Volume

218

Start / End Page

57 / 65

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stroke Volume
  • Sitagliptin Phosphate
  • Proportional Hazards Models
  • North America
  • Middle Aged
  • Male
  • Latin America
  • Kaplan-Meier Estimate
  • Hypoglycemic Agents
 

Citation

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Bhatt, A. S., Luo, N., Solomon, N., Pagidipati, N. J., Ambrosio, G., Green, J. B., … TECOS Study Group. (2019). International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS. Am Heart J, 218, 57–65. https://doi.org/10.1016/j.ahj.2019.08.016
Bhatt, Ankeet S., Nancy Luo, Nicole Solomon, Neha J. Pagidipati, Giuseppe Ambrosio, Jennifer B. Green, Darren K. McGuire, et al. “International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS.Am Heart J 218 (December 2019): 57–65. https://doi.org/10.1016/j.ahj.2019.08.016.
Bhatt AS, Luo N, Solomon N, Pagidipati NJ, Ambrosio G, Green JB, et al. International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS. Am Heart J. 2019 Dec;218:57–65.
Bhatt, Ankeet S., et al. “International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS.Am Heart J, vol. 218, Dec. 2019, pp. 57–65. Pubmed, doi:10.1016/j.ahj.2019.08.016.
Bhatt AS, Luo N, Solomon N, Pagidipati NJ, Ambrosio G, Green JB, McGuire DK, Standl E, Cornel JH, Halvorsen S, Lopes RD, White HD, Holman RR, Peterson ED, Mentz RJ, TECOS Study Group. International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS. Am Heart J. 2019 Dec;218:57–65.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2019

Volume

218

Start / End Page

57 / 65

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stroke Volume
  • Sitagliptin Phosphate
  • Proportional Hazards Models
  • North America
  • Middle Aged
  • Male
  • Latin America
  • Kaplan-Meier Estimate
  • Hypoglycemic Agents