International variations in the clinical, diagnostic, and treatment characteristics of emergency department patients with acute heart failure syndromes.
OBJECTIVE
Results from investigations in one area of the world may not translate to another if patient characteristics and practices differ. We examine differences in the presentation and management of emergency department (ED) patients with dyspnoea from acute heart failure syndromes (AHFS) between the USA, Western Europe, and Eastern Europe.


RESULTS
The URGENT Dyspnoea study was a multinational prospective observational study of dyspnoeic ED patients with AHFS from 18 countries. Acute heart failure syndrome patients from the USA and Western and Eastern Europe underwent dyspnoea assessments within 1 h of the first physician evaluation. Patient characteristics, evaluation, and treatments were compared between geographical regions using analysis of variance and χ(2) tests. Four hundred and ninety-three patients with AHFS met the inclusion criteria. Participants in the USA were more frequently non-white, younger, on chronic beta-blocker therapy, and with an ejection fraction ≤40% when compared with Eastern and Western Europe. Patients from Eastern Europe were more likely to present with de novo heart failure and have ischaemic electrocardiogram changes. Pulmonary oedema was more common on chest radiograph in Western Europe, but natriuretic peptide levels were elevated in all three regions. Diuretic use was similar across all the regions. Intravenous nitroglycerin was used more frequently in Eastern (32.8%) and Western Europe (24.4%) compared with the USA (2.5%).


CONCLUSIONS
International differences in AHFS presentations and management between regions suggest results from clinical trials in one region may not translate directly to another. These differences should be considered when designing trials and interpreting the results from clinical investigations.
Collins
Sean P
SP
Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA. collinsp@ucmail.uc.edu
Pang
Peter S
PS
Lindsell
Christopher J
CJ
Kyriacou
Demetrios N
DN
Storrow
Alan B
AB
Hollander
Judd E
JE
Kirk
J Douglas
JD
Miller
Chadwick D
CD
Nowak
Richard
R
Peacock
W Frank
WF
Tavares
Miguel
M
Mebazaa
Alexandre
A
Gheorghiade
Mihai
M
D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D019468:Disease Management; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D005996:Nitroglycerin / Q000008:administration & dosage; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013902:Radiography, Thoracic
D005996:Nitroglycerin
Eur Heart J. 2006 Nov;27(22):2725-36
17000631
J Am Coll Cardiol. 2008 Nov 11;52(20):1640-8
18992654
Am Heart J. 2007 Jun;153(6):1021-8
17540205
Eur Heart J. 2010 Apr;31(7):832-41
19906690
J Am Coll Cardiol. 2007 Aug 21;50(8):768-77
17707182
Am Heart J. 2009 Sep;158(3):437-43
19699868
Am J Ther. 2008 Jul-Aug;15(4):299-303
18645329
Eur Heart J. 2008 Mar;29(6):816-24
18310669
Eur J Heart Fail. 2008 Feb;10(2):165-9
18279771
JAMA. 2007 Nov 7;298(17):2009-19
17986694
Ann Emerg Med. 2009 Jun;53(6):748-57
19232777
Ann Emerg Med. 2007 Aug;50(2):144-52
17509731
JAMA. 2007 Mar 28;297(12):1332-43
17384438
Int J Cardiol. 2010 Sep 3;143(3):309-16
19371959
Heart. 2008 Feb;94(2):172-7
18003672
Eur Heart J. 2003 Mar;24(5):442-63
12633546
Am Heart J. 2005 Feb;149(2):209-16
15846257
JAMA. 2002 Mar 27;287(12):1531-40
11911755
Am Heart J. 2008 Jan;155(1):9-18
18082483
Eur J Heart Fail. 2008 Feb;10(2):201-13
18279775
Eur J Heart Fail. 2010 May;12(5):499-507
20228387
Lancet. 1998 Feb 7;351(9100):389-93
9482291