Geographic Disparities in Heart Failure Clinical Outcomes
Summary
Heart failure is a global health challenge characterised by markedly different clinical outcomes across regions. Incidence and prevalence vary according to demographic transitions, socioeconomic status and the organisation of healthcare systems. In high-income settings, advanced diagnostic tools, guideline-directed medical therapies and structured follow-up have improved survival, whereas many low- and middle-income regions still face delayed diagnosis, restricted access to evidence-based treatments and higher in-hospital mortality. Environmental factors, genetic predispositions and variability in healthcare delivery further amplify these disparities. For example, rates of hospital admission, re-admission and mortality can be two to three times higher in underserved areas, reflecting differences in early detection, comorbidity management and post-discharge support. Moreover, patterns of aetiology differ: ischaemic heart disease predominates in industrialised nations, while hypertensive or rheumatic heart disease remain major contributors in other regions. Understanding these variations is essential for tailoring public health strategies, allocating resources effectively and closing the gap in outcomes worldwide.
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Geographic Disparities in Heart Failure Clinical Outcomes publication trend
The graph below shows the total number of articles in geographic disparities in heart failure clinical outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Left ventricle ejection fraction (LVEF): The proportion of blood ejected from the left ventricle with each contraction, expressed as a percentage.
Acute decompensated heart failure (ADHF): A rapid worsening of heart failure signs and symptoms requiring urgent medical intervention.
New York Heart Association (NYHA) classification: A scale from I to IV grading heart failure severity based on physical activity limitation and symptoms.
Incidence rate: The number of new cases of a condition occurring in a defined population over a specified period, usually expressed per 100 or 1,000 person-years.
Hazard ratio: A statistic indicating the relative risk of an event occurring in one group compared with another over time in survival analysis.
References
- Impact of Geographic Region on the COMMANDER-HF Trial. JACC Heart Failure (2021).
- Characteristics and Outcomes of Heart Failure Patients from a Middle-Income Country: The RECOLFACA Registry. Global Heart (2022).
- American Registry of Ambulatory or acutely decompensated heart failure (AMERICCAASS Registry): First 1000 patients. Clinical Cardiology (2023).
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