Socioeconomic Status and Outcomes in Heart Failure With Reduced Ejection Fraction From Asia
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 Hsi Ling, Houng Bang Liew, Calambur Narasimhan, Tachapong Ngarmukos, Sang Weon Park, Eugenio B 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
Abstract
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.