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International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS
International differences in management/outcomes among patients with type 2 diabetes and heart failure (HF) are not well characterized. We sought to evaluate geographic variation in treatment and outcomes among these patients. Among 14,671 participants in the Trial Evaluating Cardiovascular Outcomes...
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| Published in: | The American heart journal 2019-12, Vol.218, p.57-65 |
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| Main Authors: | , , , , , , , , , , , , , , |
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| container_end_page | 65 |
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| container_start_page | 57 |
| container_title | The American heart journal |
| container_volume | 218 |
| creator | Bhatt, Ankeet S. Luo, Nancy Solomon, Nicole Pagidipati, Neha J. Ambrosio, Giuseppe Green, Jennifer B. McGuire, Darren K. Standl, Eberhard Cornel, Jan H. Halvorsen, Sigrun Lopes, Renato D. White, Harvey D. Holman, Rury R. Peterson, Eric D. Mentz, Robert J. |
| description | International differences in management/outcomes among patients with type 2 diabetes and heart failure (HF) are not well characterized. We sought to evaluate geographic variation in treatment and outcomes among these patients.
Among 14,671 participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), those with HF at baseline and a documented ejection fraction (EF) (N = 1591; 10.8%) were categorized by enrollment region (North America, Latin America, Western Europe, Eastern Europe, and Asia Pacific). Cox models were used to examine the association between geographic region and the primary outcome of all-cause mortality (ACM) or hospitalization for HF (hHF) in addition to ACM alone. Analyses were stratified by those with EF |
| doi_str_mv | 10.1016/j.ahj.2019.08.016 |
| format | article |
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Among 14,671 participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), those with HF at baseline and a documented ejection fraction (EF) (N = 1591; 10.8%) were categorized by enrollment region (North America, Latin America, Western Europe, Eastern Europe, and Asia Pacific). Cox models were used to examine the association between geographic region and the primary outcome of all-cause mortality (ACM) or hospitalization for HF (hHF) in addition to ACM alone. Analyses were stratified by those with EF <40% or EF ≥40%. The majority of participants with HF were enrolled in Eastern Europe (53%). Overall, 1,267 (79.6%) had EF ≥40%. β-Blocker (83%) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (86%) use was high across all regions in patients with EF <40%. During a median follow-up of 2.9 years, Eastern European participants had lower rates of ACM/hHF compared with North Americans (adjusted hazard ratio: 0.45; 95% CI: 0.32-0.64). These differences were seen only in the EF ≥40% subgroup and not the EF <40% subgroup. ACM was similar among Eastern European and North American participants (adjusted hazard ratio: 0.79; 95% CI: 0.44-1.45).
Significant variation exists in the clinical features and outcomes of HF patients across regions in TECOS. Patients from Eastern Europe had lower risk-adjusted ACM/hHF than those in North America, driven by those with EF ≥40%. These data may inform the design of future international trials.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2019.08.016</identifier><identifier>PMID: 31707329</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adrenergic beta-Antagonists - therapeutic use ; Aged ; Angiotensin-converting enzyme inhibitors ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Asia ; Cardiovascular disease ; Cause of Death ; Clinical outcomes ; Clinical trials ; Comorbidity ; Congestive heart failure ; Coronary vessels ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - mortality ; Diuretics - therapeutic use ; Double-Blind Method ; Enrollments ; Enzyme inhibitors ; Europe ; Evaluation ; Female ; Follow-Up Studies ; Geographical variations ; Health hazards ; Heart failure ; Heart Failure - complications ; Heart Failure - drug therapy ; Heart Failure - mortality ; Hemoglobin ; Hospitalization ; Humans ; Hypoglycemic Agents - therapeutic use ; Kaplan-Meier Estimate ; Latin America ; Male ; Middle Aged ; Mortality ; North America ; Patients ; Peptidyl-dipeptidase A ; Proportional Hazards Models ; Sitagliptin Phosphate - therapeutic use ; Stroke Volume ; Subgroups ; Treatment Outcome</subject><ispartof>The American heart journal, 2019-12, Vol.218, p.57-65</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><rights>2019. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-6fc7de3dc85830c24741da835a963eddd2badea8746020a7b5ab04b4eb2c265a3</citedby><cites>FETCH-LOGICAL-c381t-6fc7de3dc85830c24741da835a963eddd2badea8746020a7b5ab04b4eb2c265a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31707329$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bhatt, Ankeet S.</creatorcontrib><creatorcontrib>Luo, Nancy</creatorcontrib><creatorcontrib>Solomon, Nicole</creatorcontrib><creatorcontrib>Pagidipati, Neha J.</creatorcontrib><creatorcontrib>Ambrosio, Giuseppe</creatorcontrib><creatorcontrib>Green, Jennifer B.</creatorcontrib><creatorcontrib>McGuire, Darren K.</creatorcontrib><creatorcontrib>Standl, Eberhard</creatorcontrib><creatorcontrib>Cornel, Jan H.</creatorcontrib><creatorcontrib>Halvorsen, Sigrun</creatorcontrib><creatorcontrib>Lopes, Renato D.</creatorcontrib><creatorcontrib>White, Harvey D.</creatorcontrib><creatorcontrib>Holman, Rury R.</creatorcontrib><creatorcontrib>Peterson, Eric D.</creatorcontrib><creatorcontrib>Mentz, Robert J.</creatorcontrib><creatorcontrib>TECOS Study Group</creatorcontrib><title>International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>International differences in management/outcomes among patients with type 2 diabetes and heart failure (HF) are not well characterized. We sought to evaluate geographic variation in treatment and outcomes among these patients.
Among 14,671 participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), those with HF at baseline and a documented ejection fraction (EF) (N = 1591; 10.8%) were categorized by enrollment region (North America, Latin America, Western Europe, Eastern Europe, and Asia Pacific). Cox models were used to examine the association between geographic region and the primary outcome of all-cause mortality (ACM) or hospitalization for HF (hHF) in addition to ACM alone. Analyses were stratified by those with EF <40% or EF ≥40%. The majority of participants with HF were enrolled in Eastern Europe (53%). Overall, 1,267 (79.6%) had EF ≥40%. β-Blocker (83%) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (86%) use was high across all regions in patients with EF <40%. During a median follow-up of 2.9 years, Eastern European participants had lower rates of ACM/hHF compared with North Americans (adjusted hazard ratio: 0.45; 95% CI: 0.32-0.64). These differences were seen only in the EF ≥40% subgroup and not the EF <40% subgroup. ACM was similar among Eastern European and North American participants (adjusted hazard ratio: 0.79; 95% CI: 0.44-1.45).
Significant variation exists in the clinical features and outcomes of HF patients across regions in TECOS. Patients from Eastern Europe had lower risk-adjusted ACM/hHF than those in North America, driven by those with EF ≥40%. These data may inform the design of future international trials.</description><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Aged</subject><subject>Angiotensin-converting enzyme inhibitors</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Asia</subject><subject>Cardiovascular disease</subject><subject>Cause of Death</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Comorbidity</subject><subject>Congestive heart failure</subject><subject>Coronary vessels</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes Mellitus, Type 2 - mortality</subject><subject>Diuretics - therapeutic use</subject><subject>Double-Blind Method</subject><subject>Enrollments</subject><subject>Enzyme inhibitors</subject><subject>Europe</subject><subject>Evaluation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Geographical variations</subject><subject>Health hazards</subject><subject>Heart failure</subject><subject>Heart Failure - 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Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bhatt, Ankeet S.</au><au>Luo, Nancy</au><au>Solomon, Nicole</au><au>Pagidipati, Neha J.</au><au>Ambrosio, Giuseppe</au><au>Green, Jennifer B.</au><au>McGuire, Darren K.</au><au>Standl, Eberhard</au><au>Cornel, Jan H.</au><au>Halvorsen, Sigrun</au><au>Lopes, Renato D.</au><au>White, Harvey D.</au><au>Holman, Rury R.</au><au>Peterson, Eric D.</au><au>Mentz, Robert J.</au><aucorp>TECOS Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2019-12</date><risdate>2019</risdate><volume>218</volume><spage>57</spage><epage>65</epage><pages>57-65</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><abstract>International differences in management/outcomes among patients with type 2 diabetes and heart failure (HF) are not well characterized. We sought to evaluate geographic variation in treatment and outcomes among these patients.
Among 14,671 participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), those with HF at baseline and a documented ejection fraction (EF) (N = 1591; 10.8%) were categorized by enrollment region (North America, Latin America, Western Europe, Eastern Europe, and Asia Pacific). Cox models were used to examine the association between geographic region and the primary outcome of all-cause mortality (ACM) or hospitalization for HF (hHF) in addition to ACM alone. Analyses were stratified by those with EF <40% or EF ≥40%. The majority of participants with HF were enrolled in Eastern Europe (53%). Overall, 1,267 (79.6%) had EF ≥40%. β-Blocker (83%) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (86%) use was high across all regions in patients with EF <40%. During a median follow-up of 2.9 years, Eastern European participants had lower rates of ACM/hHF compared with North Americans (adjusted hazard ratio: 0.45; 95% CI: 0.32-0.64). These differences were seen only in the EF ≥40% subgroup and not the EF <40% subgroup. ACM was similar among Eastern European and North American participants (adjusted hazard ratio: 0.79; 95% CI: 0.44-1.45).
Significant variation exists in the clinical features and outcomes of HF patients across regions in TECOS. Patients from Eastern Europe had lower risk-adjusted ACM/hHF than those in North America, driven by those with EF ≥40%. These data may inform the design of future international trials.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31707329</pmid><doi>10.1016/j.ahj.2019.08.016</doi><tpages>9</tpages></addata></record> |
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| source | Elsevier |
| subjects | Adrenergic beta-Antagonists - therapeutic use Aged Angiotensin-converting enzyme inhibitors Angiotensin-Converting Enzyme Inhibitors - therapeutic use Asia Cardiovascular disease Cause of Death Clinical outcomes Clinical trials Comorbidity Congestive heart failure Coronary vessels Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - mortality Diuretics - therapeutic use Double-Blind Method Enrollments Enzyme inhibitors Europe Evaluation Female Follow-Up Studies Geographical variations Health hazards Heart failure Heart Failure - complications Heart Failure - drug therapy Heart Failure - mortality Hemoglobin Hospitalization Humans Hypoglycemic Agents - therapeutic use Kaplan-Meier Estimate Latin America Male Middle Aged Mortality North America Patients Peptidyl-dipeptidase A Proportional Hazards Models Sitagliptin Phosphate - therapeutic use Stroke Volume Subgroups Treatment Outcome |
| title | International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS |
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