ArticleClinical research in cardiology : official journal of the German Cardiac Society2020
Geographical differences in heart failure characteristics and treatment across Europe: results from the BIOSTAT-CHF study.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.
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Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it, 15 citations in OpenAlex.
- Carbohydrate antigen 125 and clinical outcomes in heart failure: systematic review and meta-analysis.BMC cardiovascular disorders · 2025Pooled it
- Use of Guideline-Recommended Heart Failure Drugs in High-, Middle-, and Low-Income Countries: A Systematic Review and Meta-Analysis.Global heart · 2024Pooled it
- 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
- Heart failure burden and care among cardiology inpatients: insights from the Hellenic Cardiorenal Morbidity Snapshot (HECMOS) study.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Understanding Geographic Variations in Heart Failure Clinical Trials.Current heart failure reports · 2026Review
- Treatment gaps in guideline-directed medical therapy for HFrEF in Singapore: findings from a multicentre retrospective cohort study.BMJ open · 2026Observational
- Quality of care delivery in patients with acute heart failure: insights from the international REPORT-HF registry.EClinicalMedicine · 2025Article
- A practical approach to the guideline-directed pharmacological treatment of heart failure with reduced ejection fraction.ESC heart failure · 2023Review
- Factors associated with in-hospital mortality and adverse outcomes during the vulnerable post-discharge phase after the first episode of acute heart failure: results of the NOVICA-2 study.Clinical research in cardiology : official journal of the German Cardiac Society · 2021Article
- An AI-Enabled, Patient-Centred Digital Platform for Integrated Chronic Heart Failure Management: Architecture, Validation and Clinical Insights.Healthcare technology lettersArticle
Corrections and comments
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Authors and funding
15 authors at 9 institutions in 9 countries.
Funding
Abstract
backgroundGeographical differences may impact the treatment of heart failure (HF) and the results of clinical trials. We have investigated the differences between geographical areas across Europe in the BIOSTAT-CHF program.
methodsPatients with worsening HF enrolled in BIOSTAT-CHF were subdivided, according to the European geographical areas, into those from Northern countries (The Netherlands, Norway, Sweden, UK), Central countries (Germany, Poland, Serbia, Slovenia), and Mediterranean countries (France, Greece, Italy). Patients were compared for baseline characteristics, treatment, and outcomes. The primary endpoint was a composite of all-cause mortality or HF hospitalization.
resultsAmong 2516 patients enrolled in BIOSTAT-CHF, 814 (32.3%) were from Northern European centers, 816 (32.4%) from Central European centers, and 886 (35.2%) from Mediterranean centers. Patients from Northern European centers were older, had more severe signs and symptoms of HF, and with lower incidence of non-cardiac comorbidities such as chronic kidney dysfunction, diabetes and, hypertension, compared to those from the Central and Mediterranean centers. Patients receiving ≥ 50% of the target dose of both ACE-I/ARB after the up-titration phase were higher in the Northern European centers compared with the other regions (60% versus 58.7% in the Central European centers and 46.5% in the Mediterranean ones; p < 0.001). The primary endpoint occurred at a higher rate in the Northern centers (44.3% versus 37.4% in central centers and 39.6% in Mediterranean centers; p = 0.014), this difference became non-significant after the adjustment for important confounders. Importantly, treatment up-titration reduced the event rates regardless of the geographical region (p for interaction > 0.05).
conclusionThe BIOSTAT-CHF study showed significant differences in the clinical features, treatment and prognosis in European patients with HF. Patients from the Mediterranean centers less often had the HF treatments up-titrated; however, the treatment up-titration benefited patients irrespective of their geographical region and should be part of the "default" clinical practice.
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