{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:05:48Z","timestamp":1791266748427,"version":"4.1.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2015,1,6]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>International geographic differences in outcomes may exist for clinical trials of heart failure and reduced ejection fraction (HF-REF), but there are few data for those with preserved ejection fraction (HF-PEF).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              We analyzed outcomes by international geographic region in the Irbesartan in Heart Failure with Preserved systolic function trial (I-Preserve), the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved trial, the CHARM-Alternative and CHARM\u2013Added HF-REF trials, and the Controlled Rosuvastatin Multinational Trial in HF-REF (CORONA). Crude rates of heart failure hospitalization varied by geographic region, and more so for HF-PEF than for HF-REF. Rates in patients with HF-PEF were highest in the United States\/Canada (HF hospitalization rate 7.6 per 100 patient-years in I-Preserve; 8.8 in CHARM-Preserved), intermediate in Western Europe (4.8\/100 and 4.7\/100), and lowest in Eastern Europe\/Russia (3.3\/100 and 2.8\/100). The difference between the United States\/Canada versus Eastern Europe\/Russia persisted after adjustment for key prognostic variables: adjusted hazard ratios 1.34 (95% confidence interval, 1.01\u20131.74;\n              <jats:italic>P<\/jats:italic>\n              =0.04) in I-Preserve and 1.85 (95% confidence interval, 1.17\u20132.91;\n              <jats:italic>P<\/jats:italic>\n              =0.01) in CHARM-Preserved. In HF-REF, rates of HF hospitalization were slightly lower in Western Europe compared with other regions. For both HF-REF and HF-PEF, there were few regional differences in rates of all-cause or cardiovascular mortality.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>The differences in event rates observed suggest there is international geographic variation in 1 or more of the definition and diagnosis of HF-PEF, the risk profile of patients enrolled, and the threshold for hospitalization, which has implications for the conduct of future global trials.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.114.012284","type":"journal-article","created":{"date-parts":[[2014,11,19]],"date-time":"2014-11-19T04:36:11Z","timestamp":1416371771000},"page":"43-53","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":81,"title":["International Geographic Variation in Event Rates in Trials of Heart Failure With Preserved and Reduced Ejection Fraction"],"prefix":"10.1161","volume":"131","author":[{"given":"S\u00f8ren L.","family":"Kristensen","sequence":"first","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pardeep S.","family":"Jhund","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Solomon","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kjekshus","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"McKelvie","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Zile","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher B.","family":"Granger","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Wikstrand","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Komajda","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter E.","family":"Carson","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Pfeffer","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Swedberg","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Wedel","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim","family":"Yusuf","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J. V.","family":"McMurray","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom (S.L.K., P.S.J., J.J.V.M.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.L.K.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.K.); Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, MA (S.D.S., M.A.P.); the Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway (J.K.); Hamilton Health..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.07.056"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.03.057"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.06.006"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2001.117600"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1313731"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2013.10.006"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14284-5"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14285-7"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14283-3"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706201"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0805450"},{"key":"e_1_3_3_13_2","article-title":"Diagnosis and Management of Heart Failure with Preserved Ejection Fraction: 10 Key Lessons.","author":"Af\u015finoktay A","year":"2013","unstructured":"Af\u015finoktay A, Shah SJ. 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