title: Differences in treatment, outcomes, and quality of life among patients with heart failure in Canada and the United States.
abstract: OBJECTIVE
  The aim of this study was to compare clinical outcomes, resource utilization, and health-related quality of life between Canadian and U.S. patients enrolled in ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure). A further aim was to supplement the within-trial analysis with a contemporaneous population-based comparison of all patients hospitalized with primary diagnoses of heart failure (HF) in the 2 countries.
  
  
  BACKGROUND
  Little is known about intercountry differences in outcomes of patients with HF in Canada and the United States.
  
  
  METHODS
  Trial patients consisted of 465 Canadian and 2,684 U.S. patients enrolled in ASCEND-HF. Population-level cohorts consisted of 1.9 million U.S. and 81,016 Canadians hospitalized for HF in 2007 and 2008.
  
  
  RESULTS
  Canadian patients in ASCEND-HF were older, were more likely to be white, and had lower body weights and blood pressures than U.S. patients. Canadians also had lower baseline-adjusted odds of 30-day mortality (odds ratio: 0.46; 95% confidence interval: 0.23 to 0.92) and better health-related quality of life than U.S. patients. In both countries, trial patients differed significantly from population-level cohorts. In contrast to ASCEND-HF, unadjusted in-hospital mortality at the population level was significantly lower in the United States (3.4%) compared with Canada (11.1%) (p < 0.01).
  
  
  CONCLUSIONS
  Intercountry differences in outcomes of patients hospitalized with HF differed significantly between trial and population cohorts. Further study on how cardiac care is delivered in the 2 countries and how it influences the results of clinical trials and population-level outcomes, especially in the long term, is warranted. (A Study Testing the Effectiveness of Nesiritide in Patients With Acute Decompensated Heart Failure; NCT00475852).
authors.affiliation: Division of Cardiology, Department of Medicine, University of Alberta, and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada. Electronic address: pkaul@ualberta.ca.
authors.forename: Padma
authors.initials: P
authors.lastname: Kaul
authors.affiliation: Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Howlett
authors.affiliation: Division of Cardiology, Department of Medicine, University of Alberta, and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.affiliation: Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Division of Cardiology, Department of Medicine, University of Alberta, and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
authors.forename: Yinggan
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Rouleau
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Duke Translational Medicine Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.affiliation: Division of Cardiology, Department of Medicine, University of Alberta, and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
mesh_terms: D000368:Aged; D002170:Canada; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006304:Health Status; D006333:Heart Failure / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*; D011788:Quality of Life; D016896:Treatment Outcome; D014481:United States
chemical_list: D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain
keywords: hospital stay; mortality; outcomes; quality of life