title: Geographic differences in outcomes in outpatients with established atherothrombotic disease: results from the REACH Registry.
abstract: OBJECTIVE
  There are major differences in the prevalence and management of patients with atherothrombotic disease including coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral artery disease (PAD) across different geographical regions. There is, however, little data allowing comparisons of management and outcomes across broad geographic regions. We aimed to describe geographical differences in baseline characteristics, management and outcomes in stable outpatients with established atherothrombotic disease.
  
  
  RESULTS
  From the REACH Registry of atherothrombosis, patients with documented CAD, PAD or CVD and with 4-year follow-up were included. Baseline characteristics, treatments and 4-year outcomes were recorded. Event rates were compared between geographical regions and were adjusted for risk scores predicting ischemic and bleeding events. The analyses of baseline characteristics and medications according to geographical region showed marked differences. For the composite primary outcome (cardiovascular death, non-fatal myocardial infarction (MI) and non-fatal stroke), rates ranged from 12.1% in Japan to 18.2% in Eastern Europe. After adjustment, substantial variations remained: taking North America as a reference, patients from Western Europe and Japan had a lower risk of primary outcome event (hazard ratio (HR) 0.93; p = 0.045, and HR = 0.67; p < 0.001 respectively) whereas patients from Eastern Europe had a higher risk (HR = 1.24; p < 0.001). There were no obvious differences between patients from North America and those from Latin America, the Middle East and Asia.
  
  
  CONCLUSIONS
  There are important variations in the outcomes of patients with atherothrombotic across geographic regions. These observations have important implications for public health and clinical research.
authors: Université Paris-Diderot, Sorbonne Paris Cité, France; AP-HP, Hopital Bichat - Paris, France; INSERM U-698, France gregory.ducrocq@bch.aphp.fr.
authors: G
authors: G
authors: Ducrocq
authors: VA Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, USA.
authors: D L
authors: DL
authors: Bhatt
authors: Université Paris-Diderot, Sorbonne Paris Cité, France; AP-HP, Hopital Bichat - Paris, France; INSERM U-698, France.
authors: J
authors: J
authors: Labreuche
authors: Pontificia Universidad Católica de Chile, Chile.
authors: R
authors: R
authors: Corbalan
authors: Department of Epidemiology, Ben-Gurion University of the Negev, Israel.
authors: A
authors: A
authors: Porath
authors: Cardiovascular Institute & Fuwai Hospital, People's Republic of China.
authors: R
authors: R
authors: Gao
authors: Cardiology Research Center, Russian Federation, Russia.
authors: E
authors: E
authors: Panchenko
authors: National Taiwan University Hospital, Taiwan.
authors: C S
authors: CS
authors: Liau
authors: Kokura Memorial Hospital, Japan.
authors: Y
authors: Y
authors: Ikeda
authors: Tokai University, Japan.
authors: S
authors: S
authors: Goto
authors: Université Paris-Diderot, Sorbonne Paris Cité, France; AP-HP, Hopital Bichat - Paris, France; INSERM U-698, France.
authors: P
authors: P
authors: Amarenco
authors: Université Paris-Diderot, Sorbonne Paris Cité, France; AP-HP, Hopital Bichat - Paris, France; INSERM U-698, France.
authors: P G
authors: PG
authors: Steg
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D015995:Prevalence; D012042:Registries; D013927:Thrombosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Geographic differences; atherothrombotic disease; bleeding; ischemic outcomes