Heart failure mortality inversely related to wealth of country

*Africans, Indians are four times more likely to die from cardiac diseases than Europeans

Death in patients with heart failure is inversely related to the wealth of the country they live in, according to late breaking results from the INTERCHF study presented over the weekend at Heart Failure 2017 and the 4th World Congress on Acute Heart Failure. Death rates in India and Africa were three to four times higher than those documented in Western countries.

“Heart failure is a common condition that causes morbidity and mortality worldwide,” said lead author Dr Hisham Dokainish, a principal investigator at the Population Health Research Institute (PHRI), McMaster University, Hamilton, Canada.

“Most data on heart failure have come from Western countries but the majority of the world’s population lives elsewhere,” he continued. “This study was conducted to fill large gaps in knowledge about congestive heart failure in non-Western countries.”

The International Congestive Heart Failure (INTERCHF) study was an observational cohort study that enrolled 5 823 patients with heart failure in 16 countries grouped into six regions: Africa (Mozambique, Nigeria, South Africa, Sudan, Uganda), China, India, the Middle East (Egypt, Qatar, Saudi Arabia), Southeast Asia (Malaysia, the Philippines), and South America (Argentina, Chile, Colombia, and Ecuador).

Data on each patient was collected at baseline, six months and one year and entered into the electronic data management system at PHRI. Baseline data included demographics (age, sex), cardiac and non-cardiac factors (previous heart attack or stroke, duration of congestive heart failure, diabetes mellitus, renal failure, chronic obstructive pulmonary disease), medications, socioeconomic factors (education level, literacy, employment, urban/rural setting), and heart failure aetiology.

At six months and one year data was collected on the frequency and cause of any hospitalisations in the previous six months. Information was also recorded on death and cause of death. The investigators calculated death rates in each region and adjusted for 20 variables which included demographic, clinical, and socioeconomic factors, medications, and cause of heart failure.

The overall all-cause mortality rate for the entire study population was 17 per cent. It was highest in Africa (34 per cent) and India (23 per cent), intermediate in Southeast Asia (15 per cent), and lowest in the Middle East (nine per cent), South America (nine per cent) and China (nine per cent).

Dokainish said: “Mortality in patients with heart failure was inversely related to the wealth of the country. The poorer the country, the higher the mortality, and the richer the country, the lower the mortality.”

“In Western countries the one-year mortality rate for patients with heart failure is five -10 per cent,” added Dokainish. “We’re finding two to three times that death rate in African and Indian patients.”