Trial reportJACC. Heart failure2019
Income Inequality and Outcomes in Heart Failure: A Global Between-Country Analysis.
Trial report in JACC. Heart failure, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
50 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Socio-economic inequalities and heart failure morbidity and mortality: A systematic review and data synthesis.ESC heart failure · 2025Pooled it
- Geographic region variation in patient characteristics, clinical outcomes and treatment of HFrEF in the VICTORIA trial.ESC heart failure · 2025Trial
- Development and validation of a prediction model based on machine learning algorithms for predicting the risk of heart failure in middle-aged and older US people with prediabetes or diabetes.Clinical cardiology · 2023Trial
- Regional and ethnic influences on the response to empagliflozin in patients with heart failure and a reduced ejection fraction: the EMPEROR-Reduced trial.European heart journal · 2021Trial
- Prior Heart Failure Hospitalization, Clinical Outcomes, and Response to Sacubitril/Valsartan Compared With Valsartan in HFpEF.Journal of the American College of Cardiology · 2020Trial
- Socioeconomic Inequality and Major Adverse Cardiovascular Events.JAMA network open · 2026Article
- Prevailing income-based disparities in cardiovascular events in young hospitalized adults with cannabis use disorder: insights from a population-based analysis.BMC public health · 2026Article
- The environmental exposome in heart failure risk and progression.Nature reviews. Cardiology · 2026Review
- Care and Outcomes of New-Onset Heart Failure Across Vulnerable Populations: Temporal Trends in Mortality and Treatment in a Danish Nationwide Cohort From 2003 to 2022.Journal of the American Heart Association · 2026Article
- Strategies to improve regional representation in heart failure randomized controlled clinical trials.Nature cardiovascular research · 2026Review
- Comprehensive Introduction to ASIAN-HF Registry.JACC. Asia · 2025Article
- Sex-Specific Disparities in the Female Vs Male Patient Population in Left Ventricular Assist Device Use.CJC open · 2025Review
- Race, Genetics, and Social Determinants of Health in Transthyretin Cardiac Amyloidosis: A Literature Review and Call to Action.Current cardiology reports · 2025Review
- Diversity and Inclusion Within Datasets in Heart Failure: A Systematic Review.JACC. Advances · 2025Article
- Socioeconomic disparities in multimorbidity of chronic diseases in the RaNCD cohort study.Scientific reports · 2025Article
- Pathways From Socioeconomic Factors to Major Cardiovascular Events Among Postmenopausal Veteran and Nonveteran Women: Findings From the Women's Health Initiative.Journal of the American Heart Association · 2024Article
- Health insurance and clinical outcomes in patients with chronic heart failure in Latin America: an observational study of the Colombian Heart Failure Registry (RECOLFACA).Heart and vessels · 2024Observational
- Sex differences in the impact of frailty on patients with heart failure: A retrospective cohort study.ESC heart failure · 2024Article
- Article
- Place-Based Measures of Inequity and Vision Difficulty and Blindness.JAMA ophthalmology · 2024Article
Corrections and comments
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Authors and funding
17 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThis study examined the relationship between income inequality and heart failure outcomes.
backgroundThe income inequality hypothesis postulates that population health is influenced by income distribution within a society, with greater inequality associated with worse outcomes.
methodsThis study analyzed heart failure outcomes in 2 large trials conducted in 54 countries. Countries were divided by tertiles of Gini coefficients (where 0% represented absolute income equality and 100% represented absolute income inequality), and heart failure outcomes were adjusted for standard prognostic variables, country per capita income, education index, hospital bed density, and health worker density.
resultsOf the 15,126 patients studied, 5,320 patients lived in Gini coefficient tertile 1 countries (coefficient: <33%), 6,124 patients lived in tertile 2 countries (33% to 41%), and 3,772 patients lived in tertile 3 countries (>41%). Patients in tertile 3 were younger than tertile 1 patients, were more often women, and had less comorbidity and several indicators of less severe heart failure, yet the tertile 3-to-1 hazard ratios (HRs) for the primary composite outcome of cardiovascular death or heart failure hospitalization were 1.57 (95% confidence interval [CI]: 1.38 to 1.79) and 1.48 for all-cause death (95% CI: 1.29 to 1.71) after adjustment for recognized prognostic variables. After additional adjustments were made for per capita income, education index, hospital bed density, and health worker density, these HRs were 1.46 (95% CI: 1.25 to 1.70) and 1.30 (95% CI: 1.10 to 1.53), respectively.
conclusionsGreater income inequality was associated with worse heart failure outcomes, with an impact similar to those of major comorbidities. Better understanding of the societal and personal bases of these findings may suggest approaches to improve heart failure outcomes.
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