International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS.
International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS.
复制标题
2 型糖尿病合并心力衰竭患者的特征和临床结果的国际差异：来自 TECOS 的见解。
DOI：
10.1016/j.ahj.2019.08.016
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发表时间：
2019
影响因子：
4.8
通讯作者：
Mentz,Robe
中科院分区：
文献类型：
--
作者：
Bhatt,AnkeetS;Luo,Nancy;Solomon,Nicole;Pagidipati,NehaJ;Ambrosio,Giuseppe;Green,JenniferB;McGuire,DarrenK;Standl,Eberhard;Cornel,JanH;Halvorsen,Sigrun;Lopes,RenatoD;White,HarveyD;Holman,RuryR;Peterson,EricD;Mentz,Robe
BackgroundInternational 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.Methods and resultsAmong 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).ConclusionsSignificant 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.
