Salim Yusuf

The common condition of heart failure (HF) is deadly and undertreated in most countries, including high-income countries such as Canada; but undertreatment is even more common in poorer countries and mortality is higher, a study of more than 23,000 patients in 40 countries found.

Ischemic heart disease (causing reduced blood flow to the heart) was the most common cause of HF in high-income, upper-middle-income, and lower-middle-income countries. High blood pressure was the most common cause of HF in low-income countries.

Across countries at all income levels, management of HF fell short, write investigators at the Population Health Research Population (PHRI), of McMaster University and Hamilton Health Sciences (HHS), and their global collaborators in today’s publication in JAMA.

“Chronic therapies that improve survival for patients with HF were under-used in countries, with the lowest use of combined medications and advanced therapies such as cardiac defibrillators in poorer countries,” says senior author Salim Yusuf, PHRI’s executive director, professor of medicine at McMaster, and cardiologist at HHS.

Philip Joseph

Death was significantly higher for HF patients in lower-middle-income and low-income countries; they died at twice the rate of patients in high-income countries.

Patients with HF in low-income and lower-middle-income countries also had 3 to 5 times higher risk of short-term death when hospitalized – if they got there. The lowest rates of hospitalization were experienced by patients in those countries, despite them having the highest rates of death.

“Death was more frequent than hospitalization, suggesting limited access to acute hospital care in poorer countries,” say first author Philip Joseph, a PHRI scientist and associate professor of medicine at McMaster University.

“Our registry is the first study of heart failure that includes patients from countries at different economic levels and from 5 continents,” says Yusuf. “Our data from a large number of diverse countries will be useful for planning health systems approaches to improve heart failure management globally.”

Read at JAMA.

Listen to podcast interview of Philip Joseph.

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