Regional differences in the characteristics and treatment of patients participating in an international heart failure trial. The Assessment of Treatment with Lisinopril and Survival (ATLAS) Trial Investigators.
OBJECTIVE
This study was designed to determine regional differences in patient characteristics and medication use among patients entered into an international heart failure trial.


RESULTS
Data for this analysis were derived from the Assessment of Treatment with Lisinopril and Survival Study (ATLAS), a prospective randomized comparison of high- and low-dose therapy with lisinopril in patients with New York Heart Association class II, III, or IV chronic heart failure, which enrolled 3164 patients in 291 centers in 19 countries on 3 continents. Information was collected at baseline concerning patient demographics, etiology of heart failure, accompanying conditions, prior revascularization procedures, and medication use. The primary findings were a lower incidence of ischemic cardiomyopathy in southern and western Europe, more frequent diabetes in North America, and a greater use of coronary revascularization in the United States and Canada. There was substantial variation in medication use, particularly with regard to digoxin, anticoagulants, and amiodarone.


CONCLUSIONS
Although there is considerable overlap in guidelines concerning the treatment of heart failure issued by authorities in Europe and North America, there are significant regional variations in medication use. Some, but not all, of these differences can be explained by differences in patient characteristics.
Massie
B M
BM
Department of Medicine, University of California, San Francisco, USA. massie.barry@sanfrancisco.va.gov
Cleland
J G
JG
Armstrong
P W
PW
Horowitz
J D
JD
Packer
M
M
Poole-Wilson
P A
PA
Ryden
L
L
Lars
R
R
D000368:Aged; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002170:Canada; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005060:Europe; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D017706:Lisinopril / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009656:North America; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000592:standards*; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
D000806:Angiotensin-Converting Enzyme Inhibitors; D017706:Lisinopril