• G-CHF Investigators, Philip Joseph, Ambuj Roy, Eva Lonn, Stefan Störk, John Floras, Lisa Mielniczuk, Jean-Lucien Rouleau, Jun Zhu, Anastase Dzudie, Kumar Balasubramanian, Kamilu Karaye, Khalid F AlHabib, Juan Esteban Gómez-Mesa, Kelley R Branch, Abel Makubi, Andrzej Budaj, Alvaro Avezum, Thomas Wittlinger, Georg Ertl, Charles Mondo, Nana Pogosova, Aldo Pietro Maggioni, Andres Orlandini, Alexander Parkhomenko, Ahmed ElSayed, Patricio López-Jaramillo, Alex Grinvalds, Ahmet Temizhan, Camilla Hage, Lars H Lund, Khawar Kazmi, Fernando Lanas, Sanjib Kumar Sharma, Keith Fox, McMurrayJohn J VJJVBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom., Darryl Leong, Hisham Dokainish, Aditya Khetan, Gerald Yonga, Kristian Kragholm, Kerolos Wagdy Shaker, Julius Chacha Mwita, Arif Abdullatif Al-Mulla, François Alla, Albertino Damasceno, José Silva-Cardoso, Antonio L Dans, Karen Sliwa, Martin O'Donnell, Nooshin Bazargani, Antoni Bayés-Genís, Tara McCready, Jeffrey Probstfield, and Salim Yusuf.
• Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
• JAMA. 2023 May 16; 329 (19): 165016611650-1661.

ImportanceMost epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries.ObjectiveTo examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development.Design, Setting, And ParticipantsMultinational HF registry of 23 341 participants in 40 high-income, upper-middle-income, lower-middle-income, and low-income countries, followed up for a median period of 2.0 years.Main Outcomes And MeasuresHF cause, HF medication use, hospitalization, and death.ResultsMean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper-middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower-middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper-middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower-middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper-middle-income countries (ratio = 2.4), similar in lower-middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper-middle-income countries (9.7%), then lower-middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower-middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies.Conclusions And RelevanceThis study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.

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