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Geographical differences in heart failure characteristics and treatment across Europe: results from the BIOSTAT-CHF study

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Abstract

Background

Geographical differences may impact the treatment of heart failure (HF) and the results of clinical trials. We have investigated the differences between geographical areas across Europe in the BIOSTAT-CHF program.

Methods

Patients with worsening HF enrolled in BIOSTAT-CHF were subdivided, according to the European geographical areas, into those from Northern countries (The Netherlands, Norway, Sweden, UK), Central countries (Germany, Poland, Serbia, Slovenia), and Mediterranean countries (France, Greece, Italy). Patients were compared for baseline characteristics, treatment, and outcomes. The primary endpoint was a composite of all-cause mortality or HF hospitalization.

Results

Among 2516 patients enrolled in BIOSTAT-CHF, 814 (32.3%) were from Northern European centers, 816 (32.4%) from Central European centers, and 886 (35.2%) from Mediterranean centers. Patients from Northern European centers were older, had more severe signs and symptoms of HF, and with lower incidence of non-cardiac comorbidities such as chronic kidney dysfunction, diabetes and, hypertension, compared to those from the Central and Mediterranean centers. Patients receiving ≥ 50% of the target dose of both ACE-I/ARB after the up-titration phase were higher in the Northern European centers compared with the other regions (60% versus 58.7% in the Central European centers and 46.5% in the Mediterranean ones; p < 0.001). The primary endpoint occurred at a higher rate in the Northern centers (44.3% versus 37.4% in central centers and 39.6% in Mediterranean centers; p = 0.014), this difference became non-significant after the adjustment for important confounders. Importantly, treatment up-titration reduced the event rates regardless of the geographical region (p for interaction > 0.05).

Conclusion

The BIOSTAT-CHF study showed significant differences in the clinical features, treatment and prognosis in European patients with HF. Patients from the Mediterranean centers less often had the HF treatments up-titrated; however, the treatment up-titration benefited patients irrespective of their geographical region and should be part of the “default” clinical practice.

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Funding

BIOSTAT-CHF was funded by a grant from the European Commission: FP7-242209-BIOSTAT-CHF.

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Authors and Affiliations

  1. Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardio-Thoracic Department, University of Brescia, Civil Hospitals, Brescia, Italy

    Carlo Mario Lombardi, Valentina Carubelli & Marco Metra

  2. French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT), National Institute of Health and Medical Research (INSERM), Center for Clinical Multidisciplinary Research 1433, INSERM U1116, University of Lorraine, Regional University Hospital of Nancy, Nancy, France

    João Pedro Ferreira & Faiez Zannad

  3. Department of Innovative Clinical Trials, University Medical Centre Göttingen (UMG), Robert-Koch-Straße, 37075, Göttingen, Germany

    Stefan D. Anker

  4. Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, Glasgow, UK

    John G. Cleland

  5. University of Bergen, Bergen, Norway

    Kenneth Dickstein

  6. Stavanger University Hospital, Stavanger, Norway

    Kenneth Dickstein

  7. Heart Failure Unit, Department of Cardiology, School of Medicine, National and Kopodistrian University of Athens, Athens University Hospital Attikon, Rimini 1, 12462, Athens, Greece

    Gerasimos Filippatos

  8. Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK

    Chim C. Lang

  9. Department of Cardiovascular Sciences, University of Leicester, and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK

    Leong L. Ng

  10. Department of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland

    Piotr Ponikowski

  11. Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Groby Rd, Leicester, LE3 9QP, UK

    Nilesh J. Samani

  12. Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands

    Dirk J. van Veldhuisen & Adriaan Voors

  13. Centre for Heart Diseases, University Hospital, Borowska 213, 50-556, Wroclaw, Poland

    Piotr Ponikowski

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  1. Carlo Mario Lombardi
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  2. João Pedro Ferreira
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  3. Valentina Carubelli
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  4. Stefan D. Anker
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  5. John G. Cleland
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  8. Chim C. Lang
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  9. Leong L. Ng
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  13. Faiez Zannad
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  14. Adriaan Voors
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  15. Marco Metra
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Correspondence to Carlo Mario Lombardi.

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The authors declare no competing financial interest with this post-hoc analysis.

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Lombardi, C.M., Ferreira, J.P., Carubelli, V. et al. Geographical differences in heart failure characteristics and treatment across Europe: results from the BIOSTAT-CHF study. Clin Res Cardiol 109, 967–977 (2020). https://doi.org/10.1007/s00392-019-01588-7

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