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Current Vascular Pharmacology

Editor-in-Chief

ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Research Article

Clinical Features, Socioeconomic Status, Management, and Outcomes of Acute Heart Failure: PEACE MENA Registry Phase I Results

Author(s): Hanan AlBackr, Khalid F. Alhabib*, Kadhim Sulaiman, Amal Jamee, Mohamed Sobhy, Salim Benkhedda, Sobhi Dada, Ayman Hammoudeh, Habib Gamra, Ahmed Al-Motarreb, Fahad Alkindi, Mohammad I Amin, Magdi G. Yousif, Hasan A. Farhan, Nadia Fellat, Wael Almahmeed, Mohammad Al Jarallah, Prashanth Panduranga, Magdy Abdelhamid, Ihab Ghaly, Dahlia Djermane, Ahcene Chibane, Hadi Skouri, Mohamad Jarrah, Hassen Amor, Nora K. Alsagheer, Mohammed A. Hozayen, Hosameldin S. Ahmed, Muhammad Ali, Anhar Ullah, Ayman Al Saleh and Faiez Zannad

Volume 21, Issue 4, 2023

Published on: 26 June, 2023

Page: [257 - 267] Pages: 11

DOI: 10.2174/1570161121666230525111259

Price: $65

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Abstract

Introduction: PEACE MENA (Program for the Evaluation and Management of Cardiac Events in the Middle East and North Africa) is a prospective registry in Arab countries for in-patients with acute myocardial infarction (AMI) or acute heart failure (AHF). Here, we report the baseline characteristics and outcomes of in-patients with AHF who were enrolled during the first 14 months of the recruitment phase.

Methods: A prospective, multi-centre, multi-country study including patients hospitalized with AHF was conducted. Clinical characteristics, echocardiogram, BNP (B-type natriuretic peptide), socioeconomic status, management, 1-month, and 1-year outcomes are reported.

Results: Between April 2019 and June 2020, a total of 1258 adults with AHF from 16 Arab countries were recruited. Their mean age was 63.3 (±15) years, 56.8% were men, 65% had monthly income ≤US$ 500, and 56% had limited education. Furthermore, 55% had diabetes mellitus, 67% had hypertension; 55% had HFrEF (heart failure with reduced ejection fraction), and 19% had HFpEF (heart failure with preserved ejection fraction). At 1 year, 3.6% had a heart failure-related device (0-22%) and 7.3% used an angiotensin receptor neprilysin inhibitor (0-43%). Mortality was 4.4% per 1 month and 11.77% per 1-year post-discharge. Compared with higher-income patients, lower-income patients had a higher 1-year total heart failure hospitalization rate (45.6 vs 29.9%, p=0.001), and the 1-year mortality difference was not statistically significant (13.2 vs 8.8%, p=0.059).

Conclusion: Most of the patients with AHF in Arab countries had a high burden of cardiac risk factors, low income, and low education status with great heterogeneity in key performance indicators of AHF management among Arab countries.

Keywords: Acute heart failure, Middle East, North Africa, PEACE MENA, AHF, HFrEF.

Graphical Abstract
[1]
Najafi F, Jamrozik K, Dobson AJ. Understanding the ‘epidemic of heart failure’: A systematic review of trends in determinants of heart failure. Eur J Heart Fail 2009; 11(5): 472-9.
[http://dx.doi.org/10.1093/eurjhf/hfp029] [PMID: 19251729]
[2]
Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37(27): 2129-200.
[http://dx.doi.org/10.1093/eurheartj/ehw128] [PMID: 27206819]
[3]
Maddox TM, Januzzi JL Jr, Allen LA, et al. 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: Answers to 10 pivotal issues about heart failure with reduced ejection fraction. J Am Coll Cardiol 2021; 77(6): 772-810.
[http://dx.doi.org/10.1016/j.jacc.2020.11.022] [PMID: 33446410]
[4]
AlHabeeb W, Akhras K, AlGhalayini K, et al. Understanding heart failure burden in Middle East Countries: Economic impact in Egypt, Saudi Arabia and United Arab Emirates. Value Health 2018; 21 (Suppl. 1): S123.
[http://dx.doi.org/10.1016/j.jval.2018.04.840]
[5]
Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics-2009 update: A report from the American heart association statistics committee and stroke statistics subcommittee. Circulation 2009; 119(3): 480-6.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.108.191259] [PMID: 19171871]
[6]
Fonarow GC, Albert NM, Curtis AB, et al. Improving evidence-based care for heart failure in outpatient cardiology practices: Primary results of the registry to improve the use of evidence-based heart failure therapies in the outpatient setting (IMPROVE HF). Circulation 2010; 122(6): 585-96.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.934471] [PMID: 20660805]
[7]
Lam CSP, Anand I, Zhang S, et al. Asian sudden cardiac death in heart failure (ASIAN‐HF) registry. Eur J Heart Fail 2013; 15(8): 928-36.
[http://dx.doi.org/10.1093/eurjhf/hft045] [PMID: 23568645]
[8]
Teixeira A, Parenica J, Park JJ, et al. Clinical presentation and outcome by age categories in acute heart failure: Results from an international observational cohort. Eur J Heart Fail 2015; 17(11): 1114-23.
[http://dx.doi.org/10.1002/ejhf.330] [PMID: 26419908]
[9]
Ibrahim BS. The frequency of systolic versus diastolic heart failure in an Egyptian cohort. Eur J Heart Fail 2003; 5(1): 41-5.
[http://dx.doi.org/10.1016/S1388-9842(02)00175-7] [PMID: 12559214]
[10]
AlHabib KF, Elasfar AA, AlBackr H, et al. Design and preliminary results of The Heart Function Assessment Registry Trial in Saudi Arabia (HEARTS) in patients with acute and chronic heart failure. Eur J Heart Fail 2011; 13(11): 1178-84.
[http://dx.doi.org/10.1093/eurjhf/hfr111] [PMID: 21873337]
[11]
Suwaidi JA, Asaad N, Al-Qahtani A, Al-Mulla AW, Singh R, Albinali HA. Prevalence and outcome of Middle-eastern Arab and South Asian patients hospitalized with heart failure: Insight from a 20-year registry in a Middle-eastern country (1991–2010). Acute Card Care 2012; 14(2): 81-9.
[http://dx.doi.org/10.3109/17482941.2012.655298] [PMID: 22295893]
[12]
Dokainish H, Teo K, Zhu J, et al. Heart failure in Africa, Asia, the middle east and South America: The INTER-CHF study. Int J Cardiol 2016; 204: 133-41.
[http://dx.doi.org/10.1016/j.ijcard.2015.11.183] [PMID: 26657608]
[13]
Alhabib KF, Gamra H, Almahmeed W, et al. Acute myocardial infarction and acute heart failure in the Middle East and North Africa: Study design and pilot phase study results from the PEACE MENA registry. PLoS One 2020; 15(7): e0236292.
[http://dx.doi.org/10.1371/journal.pone.0236292] [PMID: 32697793]
[14]
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42(36): 3599-726.
[http://dx.doi.org/10.1093/eurheartj/ehab368] [PMID: 34447992]
[15]
Levey AS, de Jong PE, Coresh J, et al. The definition, classification, and prognosis of chronic kidney disease: A KDIGO Controversies Conference report. Kidney Int 2011; 80(1): 17-28.
[http://dx.doi.org/10.1038/ki.2010.483] [PMID: 21150873]
[16]
Sulaiman K, Panduranga P, Al-Zakwani I, et al. Clinical characteristics, management, and outcomes of acute heart failure patients: Observations from the Gulf acute heart failure registry (Gulf CARE). Eur J Heart Fail 2015; 17(4): 374-84.
[http://dx.doi.org/10.1002/ejhf.245] [PMID: 25739882]
[17]
AlHabib KF, Elasfar AA, Alfaleh H, et al. Clinical features, management, and short- and long-term outcomes of patients with acute decompensated heart failure: Phase I results of the HEARTS database. Eur J Heart Fail 2014; 16(4): 461-9.
[http://dx.doi.org/10.1002/ejhf.57] [PMID: 24515441]
[18]
Nieminen MS, Brutsaert D, Dickstein K, et al. EuroHeart Failure Survey II (EHFS II): A survey on hospitalized acute heart failure patients: Description of population. Eur Heart J 2006; 27(22): 2725-36.
[http://dx.doi.org/10.1093/eurheartj/ehl193] [PMID: 17000631]
[19]
Atherton JJ, Hayward CS, Wan Ahmad WA, et al. Patient characteristics from a regional multicenter database of acute decompensated heart failure in Asia Pacific (ADHERE International-Asia Pacific). J Card Fail 2012; 18(1): 82-8.
[http://dx.doi.org/10.1016/j.cardfail.2011.09.003] [PMID: 22196846]
[20]
Abraham WT, Fonarow GC, Albert NM, et al. Predictors of in-hospital mortality in patients hospitalized for heart failure: Insights from the organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF). J Am Coll Cardiol 2008; 52(5): 347-56.
[http://dx.doi.org/10.1016/j.jacc.2008.04.028] [PMID: 18652942]
[21]
Spinar J, Parenica J, Vitovec J, et al. Baseline characteristics and hospital mortality in the acute heart failure database (AHEAD) main registry. Crit Care 2011; 15(6): R291.
[http://dx.doi.org/10.1186/cc10584] [PMID: 22152228]
[22]
Follath F, Yilmaz MB, Delgado JF, et al. Clinical presentation, management and outcomes in the acute heart failure global survey of standard treatment (ALARM-HF). Intensive Care Med 2011; 37(4): 619-26.
[http://dx.doi.org/10.1007/s00134-010-2113-0] [PMID: 21210078]
[23]
Maggioni AP. Dahlström U, Filippatos G, et al. EURObservational Research Programme: Regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 2013; 15(7): 808-17.
[http://dx.doi.org/10.1093/eurjhf/hft050] [PMID: 23537547]
[24]
Tavazzi L, Senni M, Metra M, et al. Multicenter prospective observational study on acute and chronic heart failure: One-year follow-up results of IN-HF (Italian Network on Heart Failure) outcome registry. Circ Heart Fail 2013; 6(3): 473-81.
[http://dx.doi.org/10.1161/CIRCHEARTFAILURE.112.000161] [PMID: 23476054]
[25]
Sato N, Kajimoto K, Keida T, et al. Clinical features and outcome in hospitalized heart failure in Japan (from the ATTEND Registry). Circ J 2013; 77(4): 944-51.
[http://dx.doi.org/10.1253/circj.CJ-13-0187] [PMID: 23502987]
[26]
Robert SA. SOCIOECONOMIC POSITION AND HEALTH: The independent contribution of community socioeconomic context. Annu Rev Sociol 1991; 25: 489-516.
[http://dx.doi.org/10.1146/annurev.soc.25.1.489]
[27]
Havranek EP, Mujahid MS, Barr DA, et al. Social determinants of risk and outcomes for cardiovascular disease: A scientific statement from the American Heart Association. Circulation 2015; 132(9): 873-98.
[http://dx.doi.org/10.1161/CIR.0000000000000228] [PMID: 26240271]
[28]
Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: A review of the literature. Circulation 1993; 88(4): 1973-98.
[http://dx.doi.org/10.1161/01.CIR.88.4.1973] [PMID: 8403348]
[29]
Rosengren A, Smyth A, Rangarajan S, et al. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: The Prospective Urban Rural Epidemiologic (PURE) study. Lancet Glob Health 2019; 7(6): e748-60.
[http://dx.doi.org/10.1016/S2214-109X(19)30045-2] [PMID: 31028013]
[30]
Bowry ADK, Lewey J, Dugani SB, Choudhry NK. The burden of cardiovascular disease in Low- and Middle-Income Countries: Epidemiology and management. Can J Cardiol 2015; 31(9): 1151-9.
[http://dx.doi.org/10.1016/j.cjca.2015.06.028] [PMID: 26321437]
[31]
Dewan P. Rørth R, Jhund PS, et al. Income inequality and outcomes in heart failure. JACC Heart Fail 2019; 7(4): 336-46.
[http://dx.doi.org/10.1016/j.jchf.2018.11.005] [PMID: 30738981]
[32]
Ferreira JP, Rossignol P, Dewan P, et al. Income level and inequality as complement to geographical differences in cardiovascular trials. Am Heart J 2019; 218: 66-74.
[http://dx.doi.org/10.1016/j.ahj.2019.08.019] [PMID: 31707330]
[33]
Dokainish H, Teo K, Zhu J, et al. Global mortality variations in patients with heart failure: Results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. Lancet Glob Health 2017; 5(7): e665-72.
[http://dx.doi.org/10.1016/S2214-109X(17)30196-1] [PMID: 28476564]
[34]
Callender T, Woodward M, Roth G, et al. Heart failure care in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 2014; 11(8): e1001699.
[http://dx.doi.org/10.1371/journal.pmed.1001699] [PMID: 25117081]
[35]
Potter EL, Hopper I, Sen J, Salim A, Marwick TH. Impact of socioeconomic status on incident heart failure and left ventricular dysfunction: Systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes 2019; 5(2): 169-79.
[http://dx.doi.org/10.1093/ehjqcco/qcy047] [PMID: 30295783]
[36]
Calvillo-King L, Arnold D, Eubank KJ, et al. Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: Systematic review. J Gen Intern Med 2013; 28(2): 269-82.
[http://dx.doi.org/10.1007/s11606-012-2235-x] [PMID: 23054925]
[37]
Rathore SS, Masoudi FA, Wang Y, et al. Socioeconomic status, treatment, and outcomes among elderly patients hospitalized with heart failure: Findings from the National Heart Failure Project. Am Heart J 2006; 152(2): 371-8.
[http://dx.doi.org/10.1016/j.ahj.2005.12.002] [PMID: 16875925]
[38]
Ahmed A, Fonarow GC, Zhang Y, et al. Renin-angiotensin inhibition in systolic heart failure and chronic kidney disease. Am J Med 2012; 125(4): 399-410.
[http://dx.doi.org/10.1016/j.amjmed.2011.10.013] [PMID: 22321760]
[39]
Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America. Circulation 2017; 136(6): e137-61.
[http://dx.doi.org/10.1161/CIR.0000000000000509] [PMID: 28455343]
[40]
McMurray JJV, Packer M, Desai AS, et al. Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin‐converting enzyme inhibition in patients with chronic systolic heart failure: Rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM‐HF). Eur J Heart Fail 2013; 15(9): 1062-73.
[http://dx.doi.org/10.1093/eurjhf/hft052] [PMID: 23563576]
[41]
Vaduganathan M, Claggett BL, Jhund PS, et al. Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: A comparative analysis of three randomised controlled trials. Lancet 2020; 396(10244): 121-8.
[http://dx.doi.org/10.1016/S0140-6736(20)30748-0] [PMID: 32446323]
[42]
Hernandez AF, Mi X, Hammill BG, et al. Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction. JAMA 2012; 308(20): 2097-107.
[http://dx.doi.org/10.1001/jama.2012.14795] [PMID: 23188026]
[43]
Crespo-Leiro MG, Anker SD, Maggioni AP, et al. European Society of Cardiology Heart Failure Long‐Term Registry (ESC‐HF‐LT): 1‐year follow‐up outcomes and differences across regions. Eur J Heart Fail 2016; 18(6): 613-25.
[http://dx.doi.org/10.1002/ejhf.566] [PMID: 27324686]
[44]
Kimmoun A, Takagi K, Gall E, et al. Temporal trends in mortality and readmission after acute heart failure: A systematic review and meta‐regression in the past four decades. Eur J Heart Fail 2021; 23(3): 420-31.
[http://dx.doi.org/10.1002/ejhf.2103] [PMID: 33443295]
[45]
Santas E, Palau P. Llácer P, et al. Sex‐related differences in mortality following admission for acute heart failure across the left ventricular ejection fraction spectrum. J Am Heart Assoc 2022; 11(1): e022404.
[http://dx.doi.org/10.1161/JAHA.121.022404] [PMID: 34927464]
[46]
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: ExecutiveLmmary. J Am Coll Cardiol 2022; 79(17): 1757-80.
[http://dx.doi.org/10.1016/j.jacc.2021.12.011] [PMID: 35379504]

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