{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:22:39Z","timestamp":1770834159238,"version":"3.50.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>To assess how national income level influences global variation in the diagnosis and management of heart failure with preserved ejection fraction (HFpEF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A web-based survey on HFpEF diagnosis and treatment was distributed worldwide from May to July 2023 through email, scientific societies, and social networks. Respondents provided demographic information and details on diagnostic practices, resource availability, and treatment approaches. Countries were categorized according to the 2023 World Bank income classifications: high-income countries (HICs), upper-middle-income countries (UMICs), lower-middle-income countries (LMICs), and low-income countries (LICs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>1459 physicians from 91 countries completed the survey (median age 42 years; 61% male). Income level influenced the type of clinician managing HFpEF, with cardiologists more frequently involved in UMICs and LMICs\/LICs than HICs. Respondents in HICs reported a higher proportion of HFpEF among their HF patients (40% vs 30% elsewhere; P &amp;lt; .001). Use of natriuretic peptides varied significantly across settings, as did the availability of echocardiographic parameters required for HFpEF assessment, which was highest in HICs. Screening for coronary artery disease in new HFpEF cases ranged from 22% in LMICs\/LICs to 40% in UMICs. Availability of ACE inhibitors, ARBs, MRAs, and loop diuretics showed clear income-related differences, while SGLT2 inhibitors were widely available across all groups (88%). Multi-disciplinary HF programmes were most common in HICs (62%) and least common in LMICs\/LICs (24%; P &amp;lt; .001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>National income level is associated with major differences in diagnostic testing, medication access, specialist involvement, and multi-disciplinary care for HFpEF. These disparities highlight the need for scalable, resource-adapted strategies to optimize HFpEF care globally.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag031","type":"journal-article","created":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T12:34:33Z","timestamp":1768653273000},"source":"Crossref","is-referenced-by-count":0,"title":["The impact of country income level on the management of heart failure with preserved ejection fraction: an international survey"],"prefix":"10.1093","volume":"13","author":[{"given":"Inga J","family":"Ingimarsd\u00f3ttir","sequence":"first","affiliation":[{"name":"Department of Cardiology, Landspitali University Hospital , Reykjavik ,","place":["Iceland"]},{"name":"Department of Health Sciences, Faculty of Medicine, University of Iceland , Reykjavik ,","place":["Iceland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clara","family":"Saldarriaga","sequence":"additional","affiliation":[{"name":"Pontificia Bolivariana University\u2014Antioquia\u00b4s University , Medell\u00edn ,","place":["Colombia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels C R","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zealand University Hospital , Roskilde ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hafsteinn","family":"Einarsson","sequence":"additional","affiliation":[{"name":"Department of Engineering and Natural Sciences, Faculty of Computer Science, University of Iceland , Reykjavik ,","place":["Iceland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sidney","family":"Goldfeder","sequence":"additional","affiliation":[{"name":"CardioVID\u2014Clinic , Medell\u00edn ,","place":["Colombia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4526-8129","authenticated-orcid":false,"given":"Nathan","family":"Mewton","sequence":"additional","affiliation":[{"name":"Cardiology Institute of the Hospices Civils de Lyon, Heart Failure Department, Clinical Investigation Center Inserm 1407 CarMeN Inserm 1060, University Claude Bernard Lyon 1 , Lyon ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anders","family":"Barasa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amager Hvidovre Hospital, University of Copenhagen , Copenhagen ,","place":["Denmark"]},{"name":"The African Heart Failure Association (PASCAR), Cape Town ,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Basic","sequence":"additional","affiliation":[{"name":"Department of Medicine Geriatrics and Emergency Medicine\/\u00d6stra, Region V\u00e4stra G\u00f6taland, Sahlgrenska University Hospital , Gothenburg ,","place":["Sweden"]},{"name":"Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg ,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marish I F J","family":"Oerlemans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]},{"name":"European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart\u2019 (ERN GUARDHEART), Amsterdam, The \u00a0","place":["Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3089-1222","authenticated-orcid":false,"given":"David","family":"Niederseer","sequence":"additional","affiliation":[{"name":"Hochgebirgsklinik Davos, Medicine Campus Davos , Davos ,","place":["Switzerland"]},{"name":"Department of Cardiology, Center of Translational and Experimental Cardiology (CTEC), University Heart Center Zurich, University Hospital Zurich, University of Zurich , Zurich ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar \u00d6","family":"Braun","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Sciences, Lund University and Sk\u00e5ne University Hospital , Lund ,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anastasia","family":"Shchendrygina","sequence":"additional","affiliation":[{"name":"Department of Hospital Therapy 2, I.M. 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