Disparities Among Immigrants and Native Patients in Denmark With New-Onset Heart Failure With Reduced Ejection Fraction

BACKGROUND: Worldwide, major health care variations exist in patients with heart failure (HF).

OBJECTIVES: In this study, the authors sought to examine and compare immigrants grouped by region of origin and native Danish patients presenting with new-onset heart failure with reduced ejection fraction (HFrEF).

METHODS: The authors used data from the Danish Heart Failure Registry and administrative registries comprising information on medication, comorbidity, vital status, income level, and education. The co-primary outcomes were uptitration of guideline-directed medical therapy (GDMT) and a composite of HF hospitalization and all-cause death.

RESULTS: Overall, 55,918 patients were included, of whom 94.8% were native Danish patients, 3.0% originated from Europe/Central Asia, 1.1% from the Middle East/North Africa, 0.6% from South Asia, and 0.5% from other regions. Patients from the non-Western areas were around 10 years younger (median age 62 vs 72 years) and had more diabetes (38%-50% vs 20%) and ischemic heart disease (67%-74% vs 48%) and less atrial fibrillation (9%-15% vs 32%) compared with Danish patients (all P < 0.001). At 12 months' follow-up, no major differences in attainment of ≥50% target daily doses of GDMT were observed across groups. The crude 3-year cumulative risk of HF hospitalization or all-cause death ranged from 25% to 37% and was lowest for non-Western immigrants, although this difference does not persist in age- and sex-matched analyses.

CONCLUSIONS: Patients in Denmark with HFrEF originating from non-Western parts of the world were younger and had more ischemic heart disease and diabetes and less atrial fibrillation compared with native Danish patients. The likelihood of GDMT uptitration at 12 months was similar to that of native Danish patients, whereas their risk of HF hospitalization or all-cause death was lower, although the difference between the 2 groups diminished in age- and sex-matched analyses.