Table 1. Final Model for Primary Composite End Point Based on Backward Stepwise Cox Proportional Hazard Regressiona.
| Characteristic | HR (95% CI) | χ2 | Coefficient (SE) | P Value |
|---|---|---|---|---|
| Baseline characteristic | ||||
| Diabetes mellitus | 1.36 (1.24-1.50) | 39.6 | 0.307 (0.049) | <.001 |
| HF duration >5 y | 1.50 (1.31-1.70) | 36.5 | 0.402 (0.067) | <.001 |
| Prior HF hospitalization | 1.35 (1.21-1.51) | 27.3 | 0.302 (0.058) | <.001 |
| HF duration 1-5 y | 1.37 (1.21-1.54) | 25.2 | 0.313 (0.062) | <.001 |
| Race/ethnicity | ||||
| Black | 1.67 (1.36-2.04) | 24.5 | 0.511 (0.103) | <.001 |
| Asian | 1.43 (1.23-1.66) | 21.3 | 0.357 (0.077) | <.001 |
| Not prescribed sacubitril/valsartan | 1.24 (1.13-1.36) | 20.9 | 0.214 (0.047) | <.001 |
| Region (central Europe) | 1.34 (1.18-1.52) | 19.9 | 0.291 (0.065) | <.001 |
| Ejection fraction (per 5% decrease <40%) | 1.09 (1.05-1.13) | 19.5 | 0.083 (0.019) | <.001 |
| NYHA III/IV | 1.24 (1.11-1.38) | 15.5 | 0.214 (0.054) | <.001 |
| Region (Latin America) | 1.50 (1.21-1.85) | 14.2 | 0.403 (0.110) | <.001 |
| Valvular heart disease | 1.33 (1.14-1.55) | 13.2 | 0.286 (0.079) | <.001 |
| Not prescribed β-blocker | 1.34 (1.14-1.58) | 12.7 | 0.295 (0.083) | <.001 |
| Peripheral arterial disease | 1.28 (1.11-1.47) | 11.4 | 0.245 (0.073) | .001 |
| Male | 1.22 (1.08-1.38) | 9.9 | 0.200 (0.064) | .002 |
| Bundle branch block | 1.16 (1.05-1.28) | 8.6 | 0.147 (0.051) | .004 |
| Prior MI | 1.12 (1.02-1.23) | 5.3 | 0.113 (0.049) | .02 |
| Interaction terms | ||||
| Prior hospitalization for HF from Latin America | 1.41 (0.78-2.50) | 7.8 | 0.344 (0.132) | .005 |
| Laboratory values | ||||
| Total bilirubin (for every 0.29 mg/dL increase greater than 0.58 mg/dL) | 1.11 (1.08-1.15) | 42.0 | 0.109 (0.017) | <.001 |
| Uric acid (for every 0.84 mg/dL increase greater than 6.72 mg/dL) | 1.08 (1.05-1.11) | 26.7 | 0.075 (0.014) | <.001 |
| Albumin (for every 0.1 g/dL decrease less than 4.2 g/dL) | 1.05 (1.03-1.07) | 17.5 | 0.048 (0.012) | <.001 |
| Potassium (for every 0.1 mEq/L decrease less than 4 mEq/L) | 1.07 (1.03-1.10) | 13.7 | 0.064 (0.017) | <.001 |
| Absolute neutrophils (for every 1000/mL increase below 6000/mL) | 1.07 (1.03-1.11) | 10.6 | 0.065 (0.020) | .001 |
| Hemoglobin (for every 1 g/dL decrease less than 14 g/dL) | 1.08 (1.03-1.13) | 10.5 | 0.076 (0.024) | .001 |
| LDL (for every 38.61 mg/dL increase greater than 115.83 mg/dL) | 1.15 (1.04-1.26) | 8.0 | 0.135 (0.048) | .005 |
| Urea (for every 2.8 mg/dL increase greater than 14.01 mg/dL) | 1.02 (1.00-1.04) | 5.9 | 0.021 (0.009) | .02 |
| Absolute lymphocytes (for every 1000/mL decrease less than 2500/mL) | 1.06 (1.02-1.09) | 5.2 | 0.054 (0.048) | .02 |
| Natriuretic peptides | ||||
| NTproBNP categoryb | 1.34 (1.28-1.40) | 149.1 | 0.292 (0.0240) | <.001 |
Abbreviations: BP, blood pressure; HF, heart failure; HR, hazard ratio; LDL, low-density lipoprotein; MI, myocardial infarction; NYHA, New York Heart Association; NTproBNP, N-terminal pro brain natriuretic peptide.
SI conversion factor: To convert albumin to grams per liter, multiply by 10; bilirubin to micromoles per liter, multiply by 17.104; hemoglobin to grams per liter, multiply by 10; LDL cholesterol to millimoles per liter, multiply by 0.0259; lymphocytes to ×109 per liter, multiply by 0.001; neutrophils to ×109 per liter, multiply by 0.001; potassium to millimoles per liter, multiply by 1; urea to millimoles per liter, multiply by 0.375; uric acid to micromoles per liter, multiply by 59.485.
There was a significant interaction between region, specifically Latin America and a prior history of heart failure hospitalization. Specifically, those patients with a history of HF hospitalization and from Latin America were 1.41 times more likely to experience the primary composite outcome than those from outside Latin America without a history of HF hospitalization.
NTproBNP categories: 1, <400 pg/mL; 2, 400 pg/mL-799 pg/mL; 3, 800 pg/mL-1599 pg/mL; 4, 1600 pg/mL-3199 pg/mL; 5, ≥3200 pg/mL.