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1. Socioeconomic Status and Outcomes in Heart Failure With Reduced Ejection Fraction From Asia

Author

Tiew-Hwa K. Teng, Wan Ting Tay, Arthur Mark Richards, Timothy Shi Ming Chew, Inder Anand, Wouter Ouwerkerk, Chanchal Chandramouli, Weiting Huang, Claire A. Lawson, Umesh T. Kadam, Jonathan Yap, Shirlynn Lim, Chung-Lieh Hung, Michael Ross MacDonald, Seet Yoong Loh, Wataru Shimizu, Jasper Tromp, Carolyn Su Ping Lam, Lieng Hsi Ling, Houng Bang Liew, Calambur Narasimhan, Tachapong Ngarmukos, Sang Weon Park, Eugenio Reyes, Bambang B. Siswanto, Shu Zhang, Xiaohan Fan, Keping Chen, Liqun Wu, Yucai Xie, Qi Jin, Tianyou Ling, Xinli Li, Fang Zhou, Yanli Zhou, Dongjie Xu, Haifeng Zhang, Yangang Su, Xueying Chen, Shengmei Qin, Jingfeng Wang, Xue Gong, Zhaodi Wu, Cheuk Man Yu, B K S Sastry, Arun Gopi, K Raghu, C Sridevi, Daljeet Kaur, Ajay Naik, Keyur Parikh, Anish Chandarana, Urmil Shah, Milan Chag, Hemang Baxi, Satya Gupta, Jyoti Bhatia, Vaishali Khakhkhar, Vineet Sankhla, Tejas Patel, Vipul Kapoor, Gurpreet Singh Wander, Rohit Tandon, Vijay Chopra, Manoj Kumar, Hatinder Jeet Singh Sethi, Rashmi Verma, Sanjay Mittal, Jitendra Sawhney, Manish Kr. Sharma, Mohanan Padinhare Purayil, Bambang Budi Siswanto, RS Dr Hasan Sadikin, Pintoko Tedjokusumo, Erwan Martanto, Muhammad Munawar, Jimmy Agung Pambudi, RS Siloam Karawaci, Antonia Lukito, Ingrid Pardede, Alvin Thengker, Vito Damay, Siska Suridanda Danny, Rarsari Surarso, Takashi Noda, Ikutaro Nakajima, Mitsuru Wada, Kohei Ishibashi, Takashi Kurita, Ryoubun Yasuoka, Kuniya Asai, Kohji Murai, Yoshiaki Kubota, Yuki Izumi, Takanori Ikeda, Shinji Hisatake, Takayuki Kabuki, Shunsuke Kiuchi, Nobuhisa Hagiwara, Atsushi Suzuki, Dr Tsuyoshi Suzuki, Sang-Weon Park, Suk Keun Hong, SookJin Lee, Lim Dal Soo, Dong-Hyeok Kim, Jaemin Shim, Seong-Mi Park, Seung-Young Roh, Young Hoon Kim, Mina Kim, Jong-Il Choi, Jin Oh Na, Seung Woon Rha, Hong Seog Seo, Dong Joo Oh, Chang Gyu Park, Eung Ju Kim, Sunki Lee, Boyoung Joung, Jae-Sun Uhm, Moon Hyoung Lee, In-Jeong Cho, Hui-Nam Park, Hyung-Wook Park, Jeong-Gwan Cho, Namsik Yoon, KiHong Lee, Kye Hun Kim, Seong Hwan Kim, Sahrin Saharudin, Boon Cong Beh, Yu Wei Lee, Chia How Yen, Mohd Khairi Othman, Amie-Anne Augustine, Mohd Hariz Mohd Asnawi, Roberto Angelo Mojolou, You Zhuan Tan, Aida Nurbaini Arbain, Chii Koh Wong, Razali Omar, Azmee Mohd Ghazi, Surinder Kaur Khelae, David S.P. Chew, Lok Bin Yap, Azlan Hussin, Zulkeflee Muhammad, Mohd. Ghazi Azmee, Imran Zainal Abidin, Ahmad Syadi Bin Mahmood Zhudi, Nor Ashikin Md Sari, Ganiga Srinivasaiah Sridhar, Ahmad Syadi Mahmood Zuhdi, Muhammad Dzafir Ismail, Tiong Kiam Ong, Yee Ling Cham, Ning Zan Khiew, Asri Bin Said, Alan Yean Yip Fong, Nor Hanim Mohd Amin, Keong Chua Seng, Sian Kong Tan, Kuan Leong Yew, Jones Santos, Allan Lim, Raul Lapitan, Ryan Andal, Eleanor Lopez, Kheng Leng David Sim, Boon Yew Tan, Choon Pin Lim, Louis L.Y. Teo, Laura L.H. Chan, Ping Chai, Ching Chiew Raymond Wong, Kian Keong Poh, Poh Shuan Daniel Yeo, Evelyn M. Lee, Min Er Ching, Deanna Z.L. Khoo, Min Sen Yew, Wenjie Huang, Kui Toh Gerard Leong, Jia Hao Jason See, Yaozong Benji Lim, Svenszeat Tan, Colin Yeo, Siang Chew Chai, Fazlur Rehman Jaufeerally, Haresh Tulsidas, Than Aung, Hean Yee Ong, Lee Fong Ling, Dinna Kar Nee Soon, Hung-I Yeh, Jen-Yuan Kuo, Chih-Hsuan Yen, Juey-Jen Hwang, Kuo-Liong Chien, Ta-Chen Su, Lian-Yu Lin, Jyh-Ming Juang, Yen-Hung Lin, Fu-Tien Chiang, Jiunn-Lee Lin, Yi-Lwun Ho, Chii-Ming Lee, Po-Chih Lin, Chi-Sheng Hung, Sheng-Nan Chang, Jou-Wei Lin, Chih-Neng Hsu, Wen-Chung Yu, Tze-Fan Chao, Shih-Hsien Sung, Kang-Ling Wang, Hsin-Bang Leu, Yenn-Jiang Lin, Shih-Lin Chang, Po-Hsun Huang, Li-Wei Lo, Cheng-Hsueh Wu, Hsin-Yueh Liang, Shih-Sheng Chang, Lien-Cheng Hsiao, Yu-Chen Wang, Chiung-Ray Lu, Hung-Pin Wu, Yen-Nien Lin, Ke-Wei Chen, Ping-Han Lo, Chung-Ho Hsu, Li-Chuan Hsieh, Mann Chandavimol, Teerapat Yingchoncharoen, Prasart Laothavorn, Waraporn Tiyanon, Wanwarang Wongcharoen, Arintaya Phrommintikul, Cardiovascular Centre (CVC), and Epidemiology and Data Science

Subjects
Male, Asia, heart failure, socioeconomic factors, Social class, Sudden cardiac death, Economic inequality, Quality of life, medicine, Humans, In patient, Prospective Studies, Socioeconomic status, Ejection fraction, business.industry, INCOME INEQUALITY, Stroke Volume, Middle Aged, medicine.disease, health status disparities, quality of life, CARDIOVASCULAR-DISEASE, Heart failure, PURE, Female, HEALTH, social class, Cardiology and Cardiovascular Medicine, business, SUDDEN CARDIAC DEATH, Demography
Abstract

Background: Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. Methods: We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). Results: Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (P interaction Conclusions: These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov ; Unique Identifier: NCT01633398.

Published
2021
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2. Regional Variation of Mortality in Heart Failure With Reduced and Preserved Ejection Fraction Across Asia

Author

Michael R. MacDonald, Wan Ting Tay, Tiew‐Hwa Katherine Teng, Inder Anand, Lieng Hsi Ling, Jonathan Yap, Jasper Tromp, Gurpreet S. Wander, Ajay Naik, Tachapong Ngarmukos, Bambang B. Siswanto, Chung‐Lieh Hung, A. Mark Richards, Carolyn S. P. Lam, Houng Bang Liew, Calambur Narasimhan, Sang Weon Park, Eugenio Reyes, Wataru Shimizu, Shu Zhang, Liqun Wu, Tianyou Ling, Xinli Li, Haifeng Zhang, Yangang Su, Cheuk Man Yu, B K S Sastry, Arun Gopi, K Raghu, C Sridevi, Daljeet Kaur, Keyur Parikh, Anish Chandarana, Urmil Shah, Milan Chag, Hemang Baxi, Satya Gupta, Jyoti Bhatia, Vaishali Khakhkhar, Vineet Sankhla, Tejas Patel, Vipul Kapoor, Rohit Tandon, Vijay Chopra, Manoj Kumar, Hatinder Jeet Singh Sethi, Rashmi Verma, Jitendra Sawhney, Manish Kr. Sharma, Mohanan Padinhare Purayil, Muhammad Munawar, Jimmy Agung Pambudi, Antonia Lukito, Ingrid Pardede, Alvin Thengker, Vito Damay, Siska Suridanda Danny, Rarsari Surarso, Ryoubun Yasuoka, Kuniya Asai, Takanori Ikeda, Sang‐Weon Park, Suk Keun Hong, SookJin Lee, Lim Dal Soo, Dong‐Hyeok Kim, Jaemin Shim, Seong‐Mi Park, Seung‐Young Roh, Young Hoon Kim, Mina Kim, Jong‐Il Choi, Jin Oh Na, Seung Woon Rha, Hong Seog Seo, Dong Joo Oh, Chang Gyu Park, Eung Ju Kim, Sunki Lee, Boyoung Joung, Jae‐Sun Uhm, Moon Hyoung Lee, In‐Jeong Cho, Hui‐Nam Park, Hyung‐Wook Park, Jeong‐Gwan Cho, Namsik Yoon, KiHong Lee, Kye Hun Kim, Seong Hwan Kim, Sahrin Saharudin, Boon Cong Beh, Yu Wei Lee, Chia How Yen, Mohd Khairi Othman, Amie‐Anne Augustine, Mohd Hariz Mohd Asnawi, Roberto Angelo Mojolou, You Zhuan Tan, Aida Nurbaini Arbain, Chii Koh Wong, Azmee Mohd Ghazi, Surinder Kaur Khelae, David S.P. Chew, Lok Bin Yap, Azlan Hussin, Zulkeflee Muhammad, Imran Zainal Abidin, Ahmad Syadi Bin Mahmood Zhudi, Nor Ashikin Md Sari, Ganiga Srinivasaiah Sridhar, Ahmad Syadi Mahmood Zuhdi, Muhammad Dzafir Ismail, Tiong Kiam Ong, Yee Ling Cham, Ning Zan Khiew, Asri Bin Said, Alan Yean Yip Fong, Nor Hanim Mohd Amin, Keong Chua Seng, Sian Kong Tan, Kuan Leong Yew, Jones Santos, Allan Lim, Raul Lapitan, Ryan Andal, Eleanor Lopez, Kheng Leng David Sim, Boon Yew Tan, Choon Pin Lim, Louis L.Y. Teo, Laura L. H. Chan, Ping Chai, Ching Chiew Raymond Wong, Kian Keong Poh, Poh Shuan Daniel Yeo, Evelyn M. Lee, Seet Yong Loh, Min Er Ching, Deanna Z.L. Khoo, Min Sen Yew, Wenjie Huang, Jia Hao Jason See, Yaozong Benji Lim, Svenszeat Tan, Colin Yeo, Siang Chew Chai, Fazlur Rehman Jaufeerally, Haresh Tulsidas, Than Aung, Hean Yee Ong, Lee Fong Ling, Dinna Kar Nee Soon, Hung‐I Yeh, Jen‐Yuan Kuo, Chih‐Hsuan Yen, Juey‐Jen Hwang, Kuo‐Liong Chien, Ta‐Chen Su, Lian‐Yu Lin, Jyh‐Ming Juang, Yen‐Hung Lin, Fu‐Tien Chiang, Jiunn‐Lee Lin, Yi‐Lwun Ho, Chii‐Ming Lee, Po‐Chih Lin, Chi‐Sheng Hung, Sheng‐Nan Chang, Jou‐Wei Lin, Chih‐Neng Hsu, Wen‐Chung Yu, Tze‐Fan Chao, Shih‐Hsien Sung, Kang‐Ling Wang, Hsin‐Bang Leu, Yenn‐Jiang Lin, Shih‐Lin Chang, Po‐Hsun Huang, Li‐Wei Lo, Cheng‐Hsueh Wu, Hsin‐Yueh Liang, Shih‐Sheng Chang, Lien‐Cheng Hsiao, Yu‐Chen Wang, Chiung‐Ray Lu, Hung‐Pin Wu, Yen‐Nien Lin, Ke‐Wei Chen, Ping‐Han Lo, Chung‐Ho Hsu, Li‐Chuan Hsieh, Mann Chandavimol, Teerapat Yingchoncharoen, Prasart Laothavorn, Wanwarang Wongcharoen, Arintaya Phrommintikul, and Cardiovascular Centre (CVC)

Subjects
Male, medicine.medical_specialty, Asia, Time Factors, Population, heart failure, Comorbidity, 030204 cardiovascular system & hematology, Southeast asian, Risk Assessment, Ventricular Function, Left, Sudden cardiac death, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Epidemiology, Risk of mortality, Humans, Medicine, Longitudinal Studies, Prospective Studies, Registries, 030212 general & internal medicine, education, Aged, Original Research, education.field_of_study, Ejection fraction, business.industry, Age Factors, Correction, Stroke Volume, Middle Aged, Prognosis, medicine.disease, mortality, Heart Disease Risk Factors, Heart failure, Female, epidemiology, Cardiology and Cardiovascular Medicine, business, BURDEN, SUDDEN CARDIAC DEATH, Kidney disease
Abstract

Background Data comparing outcomes in heart failure ( HF ) across Asia are limited. We examined regional variation in mortality among patients with HF enrolled in the ASIAN ‐HF (Asian Sudden Cardiac Death in Heart Failure) registry with separate analyses for those with reduced ejection fraction ( EF ; Methods and Results The ASIAN ‐ HF registry is a prospective longitudinal study. Participants with symptomatic HF were recruited from 46 secondary care centers in 3 Asian regions: South Asia (India), Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore), and Northeast Asia (South Korea, Japan, Taiwan, Hong Kong, China). Overall, 6480 patients aged >18 years with symptomatic HF were recruited (mean age: 61.6±13.3 years; 27% women; 81% with HF and reduced r EF ). The primary outcome was 1‐year all‐cause mortality. Striking regional variations in baseline characteristics and outcomes were observed. Regardless of HF type, Southeast Asians had the highest burden of comorbidities, particularly diabetes mellitus and chronic kidney disease, despite being younger than Northeast Asian participants. One‐year, crude, all‐cause mortality for the whole population was 9.6%, higher in patients with HF and reduced EF (10.6%) than in those with HF and preserved EF (5.4%). One‐year, all‐cause mortality was significantly higher in Southeast Asian patients (13.0%), compared with South Asian (7.5%) and Northeast Asian patients (7.4%; P Conclusions This first multinational prospective study shows that the outcomes in Asian patients with both HF and reduced or preserved EF are poor overall and worst in Southeast Asian patients. Region‐specific risk factors and gaps in guideline‐directed therapy should be addressed to potentially improve outcomes. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 01633398.

Published
2020

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