title: Heart failure in low- and middle-income countries: background, rationale, and design of the INTERnational Congestive Heart Failure Study (INTER-CHF).
abstract: BACKGROUND
  Although heart failure (HF) has been referred to as a global epidemic, most HF information comes from high-income countries, with little information about low-income countries (LIC) and middle-income countries (MIC) in Africa, Asia, the Middle East, and South America, which make up the majority of the world's population.
  
  
  METHODS
  The INTERnational Congestive Heart Failure Study is a cohort study of 5,813 HF patients enrolled in 108 centers in 16 LIC and MIC. At baseline, data were recorded on sociodemographic and clinical risk factors, HF etiology, laboratory variables, management, and barriers to evidence-based HF care at the patient, physician, and system levels. We sought to enroll consecutive and consenting patients ≥18 years of age with a clinical diagnosis of HF seen in outpatient clinics (2/3 of patients) or inpatient hospital wards (1/3 of patients). Patients were followed up at 6 and 12 months post-enrollment to record clinical status, treatments, and clinical outcomes such as death and hospitalizations. In the 5,813 enrolled HF patients, the mean age was 59 ± 15 years, 40% were female, 62% had a history of hypertension, 30% had diabetes, 21% had prior myocardial infarction, 64% were recruited from outpatient clinics, 36% lived in rural areas, and 29% had HF with preserved left ventricular ejection fraction.
  
  
  CONCLUSIONS
  This unique HF registry aims to systematically gather information on sociodemographic and clinical risk factors, etiologies, treatments, barriers to evidence-based care, and outcomes of HF in LIC and MIC. This information will help improve the management of HF globally.
authors.affiliation: McMaster University, Hamilton, Ontario, Canada. Electronic address: hisham.dokainish@phri.ca.
authors.forename: Hisham
authors.initials: H
authors.lastname: Dokainish
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhu
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Ambuj
authors.initials: A
authors.lastname: Roy
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Habib
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: ElSayed
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Lia
authors.initials: L
authors.lastname: Palileo
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Patricio Lopez
authors.initials: PL
authors.lastname: Jaramillo
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kamilu
authors.initials: K
authors.lastname: Karaye
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Khalid
authors.initials: K
authors.lastname: Yusoff
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Andres
authors.initials: A
authors.lastname: Orlandini
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Charles
authors.initials: C
authors.lastname: Mondo
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lanas
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Prabhakar
authors.initials: P
authors.lastname: Dorairaj
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Huffman
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Amr
authors.initials: A
authors.lastname: Badr
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elmaghawry
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Albertino
authors.initials: A
authors.lastname: Damasceno
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Emilie
authors.initials: E
authors.lastname: Belley-Cote
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Harkness
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Grinvalds
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: McKelvie
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D009017:Morbidity / Q000639:trends; D011203:Poverty; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors