Transatlantic similarities and differences in major natural history endpoints of heart failure after acute myocardial infarction: A propensity-matched study of the EPHESUS trial

Bertram Pitt, Faiez Zannad, Mihai Gheorghiade, Felipe Martínez, Thomas E. Love, Casey Daniel, Ali Ahmed*

*Corresponding author for this work

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Background: Transatlantic differences in outcomes in heart failure after acute myocardial infarction (AMI) have not been examined in propensity-matched studies. Methods: In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS), there were significant imbalances in baseline characteristics between patients from North America (n = 858) and Europe (n = 4646). Propensity scores for North America, calculated for each patient using 64 baseline characteristics, were used to assemble 298 pairs of patients who were well balanced on all measured baseline characteristics. Matched Cox regression models were used to estimate transatlantic differences in outcomes. Results: There was no transatlantic difference in all-cause mortality during 16 months of mean follow-up of (matched hazard ratio {HR}, 1.00; 95% confidence interval {CI}, 0.64-1.57; P = 1.000). All-cause hospitalization occurred in 175 (rate, 8974/10,000 person-years) and 137 (rate, 5249/10,000 person-years) patients respectively from North America and Europe (matched HR when North America was compared with Europe, 1.89; 95% CI, 1.41-2.52; P < 0.0001). Matched HRs (95% CIs) for cardiovascular and non-cardiovascular hospitalization for North America were respectively 1.35 (0.92-1.97; P = 0.125) and 1.89 (1.31-2.72; P < 0.0001). Among 5504 pre-match patients, unadjusted, multivariable-adjusted, and propensity-adjusted HRs for all-cause hospitalization for North America were 1.52 (95% CI, 1.38-1.68; P < 0.0001), 1.16 (95% CI, 1.02-1.31; P = 0.020), 1.41 (95% CI, 1.17-1.70; P < 0.0001). Conclusion: Despite major transatlantic differences in baseline characteristics, there was no difference in post-AMI mortality. The increased non-cardiovascular hospitalization in North America may in part be due to transatlantic differences in patient preferences and access to care.

Original languageEnglish (US)
Pages (from-to)309-316
Number of pages8
JournalInternational Journal of Cardiology
Volume143
Issue number3
DOIs
StatePublished - Sep 3 2010

Keywords

  • Hospitalization
  • Mortality
  • Post-AMI
  • Propensity score
  • Transatlantic variations

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Transatlantic similarities and differences in major natural history endpoints of heart failure after acute myocardial infarction: A propensity-matched study of the EPHESUS trial'. Together they form a unique fingerprint.

  • Cite this