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Socioeconomic Status and Outcomes in Heart Failure With Reduced Ejection Fraction From Asia

2021; Lippincott Williams & Wilkins; Volume: 14; Issue: 4 Linguagem: Inglês

10.1161/circoutcomes.120.006962

1941-7705

Tiew‐Hwa Katherine Teng, Wan Ting Tay, Mark Richards, Timothy Shi Ming Chew, Inder S. Anand, Wouter Ouwerkerk, Chanchal Chandramouli, Weiting Huang, Claire Lawson, Umesh Kadam, Jonathan Yap, Shir Lynn Lim, Chung‐Lieh Hung, Michael R. MacDonald, Seet Yoong Loh, Wataru Shimizu, Jasper Tromp, Carolyn S.P. Lam, Lieng H. Ling, Houng Bang Liew, Calambur Narasimhan, Tachapong Ngarmukos, Sang Weon Park, Eugenio Reyes, Bambang Budi Siswanto, Shu Zhang, Shu Zhang, Xiaohan Fan, Keping Chen, Liqun Wu, Yucai Xie, Qi Jin, Tianyou Ling, Xinli Li, Fang Zhou, Yanli Zhou, Dongjie Xu, Haifeng Zhang, Yangang Su, Xueying Chen, Shengmei Qin, Jingfeng Wang, Xue Gong, Zhaodi Wu, Cheuk‐Man Yu, Calambur Narasimhan, B.K.S. Sastry, Arun Gopi, K. Raghu, Chinta Siva Koti Rupa Sridevi, Daljeet Kaur, Ajay Naik, Keyur Parikh, Anish Chandarana, Urmil Shah, Milan Chag, Hemang Baxi, Satya Gupta, Jyoti Bhatia, Vaishali Khakhkhar, Vineet Sankhla, Tejas Patel, Vipul Kapoor, Gurpreet Singh Wander, Rohit Tandon, Vijay Chopra, Manoj Kumar, Hatinder Jeet Singh Sethi, Rashmi Verma, Sanjay Mittal, J.P.S. Sawhney, Manish Sharma, Mohanan Padinhare Purayil, Bambang Budi Siswanto, RS Dr Hasan Sadikin, Pintoko Tedjokusumo, Erwan Martanto, Muhammad Munawar, Jimmy Pambudi, RS Siloam Karawaci, Antonia Anna Lukito, Ingrid Maria Pardede, Alvin Thengker, Vito Damay, Siska Suridanda Danny, Rarsari Surarso, Takashi Noda, Ikutaro Nakajima, Mitsuru Wada, Kohei Ishibashi, Takashi Kurita, Ryoubun Yasuoka, Kuniya Asai, Kohji Murai, Yoshiaki Kubota, Yuki Izumi, Takanori Ikeda, Shinji Hisatake, Takayuki Kabuki, Shunsuke Kiuchi, Nobuhisa Hagiwara, Atsushi Suzuki, Dr Tsuyoshi Suzuki, Sang‐Weon Park, Suk Keun Hong, Sookjin Lee, Lim Dal Soo, Dong‐Hyeok Kim, Jaemin Shim, Seong‐Mi Park, Seung‐Young Roh, Young‐Hoon Kim, Mi‐Na Kim, Jong‐Il Choi, Jin Oh Na, Seung‐Woon Rha, Hong Seog Seo, Dong Joo Oh, Chang Gyu Park, Eung Ju Kim, Sunki Lee, Boyoung Joung, Jae‐Sun Uhm, Moon‐Hyoung Lee, In‐Jeong Cho, Hui-Nam Park, Hyung Wook Park, Jeong‐Gwan Cho, Namsik Yoon, Ki-Hong Lee, Kye Hun Kim, Seong Hwan Kim, Houng Bang Liew, S. Saharudin, Boon Cong Beh, Yu Wei Lee, Chia How Yen, Mohd Khairi Othman, A.A. Augustine, Mohd Hariz Mohd Asnawi, Roberto Angelo Mojolou, You Zhuan Tan, Aida Nurbaini Arbain, Chii Koh Wong, Razali Omar, Azmee Mohd Ghazi, Surinder Kaur Khelae, D.S.P. Chew, Lok Bin Yap, Azlan Hussin, Zulkeflee Muhammad, Mohd. Ghazi Azmee, Imran Zainal Abidin, Ahmad Syadi Bin Mahmood Zhudi, Nor Ashikin Md Sari, Ganiga Srinivasaiah Sridhar, Ahmad Syadi Mahmood Zuhdi, Muhammad Dzafir Ismail, Tiong Kiam Ong, Y.L. Cham, N.Z. Khiew, Asri Said, Alan Yean Yip Fong, N.H. Mohd Amin, Keong Chua Seng, Sian Kong Tan, Kuan Leong Yew, Eugenio Reyes, Jones Santos, Allan Ε. Κ. Lim, Raul Lapitan, Ryan Andal, Eleanor Lopez, Kheng Leng David Sim, Boon Yew Tan, Choon Pin Lim, Louis Teo, Laura Chan, Lieng H. Ling, Ping Chai, Ching Chiew Raymond Wong, Kian Keong Poh, Poh Shuan Daniel Yeo, Evelyn M. Lee, Min Er Ching, Deanna Khoo, Min Sen Yew, Wenjie Huang, Kui Toh Gerard Leong, Jia Hao Jason See, Yaozong Benji Lim, Svenszeat Tan, Colin Yeo, Siang Chew Chai, Fazlur Jaufeerally, Haresh Tulsidas, Than Aung, Hean Yee Ong, Lee Fong Ling, Dinna Soon, Hung-I Yeh, Jen‐Yuan Kuo, Chih‐Hsuan Yen, Juey‐Jen Hwang, Kuo‐Liong Chien, Ta‐Chen Su, Lian‐Yu Lin, Jyh‐Ming Jimmy Juang, Yen‐Hung Lin, Fu‐Tien Chiang, Jiunn‐Lee Lin, Yi‐Lwun Ho, Chi‐Ming Lee, Po‐Chih Lin, Chi‐Sheng Hung, Sheng‐Nan Chang, Jou‐Wei Lin, Chih‐Neng Hsu, Wen-Chung Yu, Tze-Fan Chao, Shih‐Hsien Sung, Kang-Ling Wang, Hsin‐Bang Leu, Yenn‐Jiang Lin, Shih‐Lin Chang, Po‐Hsun Huang, Li‐Wei Lo, Cheng‐Hsueh Wu, Hsin‐Yueh Liang, Shih‐Sheng Chang, Lien‐Cheng Hsiao, Yu-Chen Wang, Chiung‐Ray Lu, Hung‐Pin Wu, Yen‐Nien Lin, Ke‐Wei Chen, Ping‐Han Lo, Chung‐Ho Hsu, Li‐Chuan Hsieh, Tachapong Ngarmukos, Mann Chandavimol, Teerapat Yingchoncharoen, Prasart Laothavorn, Waraporn Tiyanon, Wanwarang Wongcharoen, Arintaya Phrommintikul,

Cardiovascular Issues in Pregnancy

Background: Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. Methods: We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). Results: Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (<US$1000); and 29.5% had no/only primary education. The largest disparity in treatment across regional income levels pertained to β-blocker and device therapies, with patients from low-income regions being less likely to receive these treatments compared with those from high-income regions and even greater disparity among patients with lower education status and lower household income within each regional income strata. Higher country- and patient-level socioeconomic indicators related to higher quality of life scores and lower risk of the primary composite outcome. Notably, we found a significant interaction between regional income level and both household income and education status ( P interaction <0.001 for both), where the association of low household income and low education status with poor outcomes was more pronounced in high-income compared with lower income regions. Conclusions: These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov ; Unique Identifier: NCT01633398.