Geographical differences in heart failure characteristics and treatment across Europe: results from the BIOSTAT-CHF study

Carlo Mario Lombardi (Lead / Corresponding author), João Pedro Ferreira, Valentina Carubelli, Stefan D. Anker, John G. Cleland, Kenneth Dickstein, Gerasimos Filippatos, Chim C. Lang, Leong L. Ng, Piotr Ponikowski, Nilesh J. Samani, Dirk J. van Veldhuisen, Faiez Zannad, Adriaan Voors, Marco Metra

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)
9 Downloads (Pure)


Background: Geographical 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.

Methods: Patients 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.

Results: Among 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).

Conclusion: The 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.

Original languageEnglish
Pages (from-to)967-977
Number of pages11
JournalClinical Research in Cardiology
Issue number8
Early online date29 Jan 2020
Publication statusPublished - 1 Aug 2020


  • Geographical differences
  • Geographical variations
  • Heart failure
  • Income
  • Outcomes
  • Treatment up-titration

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Geographical differences in heart failure characteristics and treatment across Europe: results from the BIOSTAT-CHF study'. Together they form a unique fingerprint.

Cite this