Global Variation in Clinical Profile, Management, and Post-Discharge Outcomes Among Patients Hospitalized For Worsening Chronic Heart Failure: Findings from the ASTRONAUT trial
Why the study?
Does geographic region affect clinical characteristics and post-discharge outcomes in patients hospitalized for worsening chronic heart failure?
Population
1615 patients hospitalized for worsening chronic heart failure with ejection fraction ≤40% enrolled in the…
Design
Cohort
Follow-up
12 months
Authors
Discussion
Loading...
Member takes
Implication
Geographic variation in adjusted HF mortality warrants caution generalizing trial results; leaves open mechanisms and region-stratified designs.
Key Points
- To investigate geographic differences in baseline clinical characteristics, evidence-based medication use, and 12-month post-discharge outcomes among patients hospitalized for worsening chronic heart failure.
- Multinational randomized trial analyzing 1,615 patients hospitalized for heart failure with left ventricular ejection fraction ≤40% randomized to aliskiren or placebo.
- Patients were evaluated across five geographic regions: 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%).
- All-cause mortality at 12 months ranged from 7.3% in North America to 26.7% in Asia/Pacific, driven primarily by sudden cardiac death, while repeat hospitalization ranged inversely from 22.7% in Latin America to 43.9% in North America.
- After adjustment for baseline characteristics, region was an independent predictor of 12-month mortality with the highest risk in Asia/Pacific compared to North America (HR 3.04, 95% CI 1.47–6.29), with no significant regional association for composite cardiovascular death or rehospitalization.
Structured PICO
Does geographic region affect clinical characteristics and post-discharge outcomes in patients hospitalized for worsening chronic heart failure?
P
Population
1615 patients hospitalized for worsening chronic heart failure (HHF) with ejection fraction ≤40% enrolled in the multinational ASTRONAUT trial.
O
Outcome
All-cause death at 12 months, repeat HHF at 12 months, and composite of cardiovascular mortality or HHFhard clinical
Geographic region is an independent predictor of mortality and repeat hospitalization in patients hospitalized for heart failure, highlighting the need to account for global differences in future clinical trials.
Cite This Study
Greene et al. (2015) studied this question.