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Comparative Study
. 2010 Nov;12(11):1253-60.
doi: 10.1093/eurjhf/hfq133. Epub 2010 Aug 25.

International variations in the clinical, diagnostic, and treatment characteristics of emergency department patients with acute heart failure syndromes

Sean P Collins  1 , Peter S Pang, Christopher J Lindsell, Demetrios N Kyriacou, Alan B Storrow, Judd E Hollander, J Douglas Kirk, Chadwick D Miller, Richard Nowak, W Frank Peacock, Miguel Tavares, Alexandre Mebazaa, Mihai Gheorghiade
Affiliations
Comparative Study

International variations in the clinical, diagnostic, and treatment characteristics of emergency department patients with acute heart failure syndromes

Sean P Collins et al. Eur J Heart Fail. 2010 Nov.

Abstract

Aims: Results from investigations in one area of the world may not translate to another if patient characteristics and practices differ. We examine differences in the presentation and management of emergency department (ED) patients with dyspnoea from acute heart failure syndromes (AHFS) between the USA, Western Europe, and Eastern Europe.

Methods and results: The URGENT Dyspnoea study was a multinational prospective observational study of dyspnoeic ED patients with AHFS from 18 countries. Acute heart failure syndrome patients from the USA and Western and Eastern Europe underwent dyspnoea assessments within 1 h of the first physician evaluation. Patient characteristics, evaluation, and treatments were compared between geographical regions using analysis of variance and χ(2) tests. Four hundred and ninety-three patients with AHFS met the inclusion criteria. Participants in the USA were more frequently non-white, younger, on chronic beta-blocker therapy, and with an ejection fraction ≤40% when compared with Eastern and Western Europe. Patients from Eastern Europe were more likely to present with de novo heart failure and have ischaemic electrocardiogram changes. Pulmonary oedema was more common on chest radiograph in Western Europe, but natriuretic peptide levels were elevated in all three regions. Diuretic use was similar across all the regions. Intravenous nitroglycerin was used more frequently in Eastern (32.8%) and Western Europe (24.4%) compared with the USA (2.5%).

Conclusion: International differences in AHFS presentations and management between regions suggest results from clinical trials in one region may not translate directly to another. These differences should be considered when designing trials and interpreting the results from clinical investigations.

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Figures

Figure 1
Figure 1
Visual analogue scale scores for dyspnoea at time of initial ED presentation and 6 h by international region.
See this image and copyright information in PMC

References

    1. Blair JE, Zannad F, Konstam MA, Cook T, Traver B, Burnett JC, Jr, Grinfeld L, Krasa H, Maggioni AP, Orlandi C, Swedberg K, Udelson JE, Zimmer C, Gheorghiade M. Continental differences in clinical characteristics, management, and outcomes in patients hospitalized with worsening heart failure results from the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan) program. J Am CollCardiol. 2008;52:1640–1648. doi:10.1016/j.jacc.2008.07.056. - DOI - PubMed
    1. Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, Hochadel M, Komajda M, Lassus J, Lopez-Sendon JL, Ponikowski P, Tavazzi L. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27:2725–2736. doi:10.1093/eurheartj/ehl193. - DOI - PubMed
    1. Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade M, Greenberg BH, O'Connor CM, Sun JL, Yancy CW, Young JB. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol. 2007;50:768–777. doi:10.1016/j.jacc.2007.04.064. - DOI - PubMed
    1. Adams KF, Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, Berkowitz RL, Galvao M, Horton DP. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE) Am Heart J. 2005;149:209–216. - PubMed
    1. Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, Dietz R, Gavazzi A, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, van Gilst WH, Widimsky J, Freemantle N, Eastaugh J, Mason J. The EuroHeart Failure survey programme—a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J. 2003;24:442–463. doi:10.1016/S0195-668X(02)00823-0. - DOI - PubMed

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