Global differences in the outcome of heart failure: implications for clinical practice.

he diagnosis, management, and treatment of heart failure n clinical practice is guided by evidence accrued from igh-quality clinical trials, cohort studies, epidemiological tudies, observational data, and a consensus of clinical xperience. Recommendations are proffered in many guideines from the continents of the world (1–5). Patients enefit from adherence to guidelines (6,7) and appropriate reatment. The expectation would be that medical practice ould be similar, or almost so, in all parts of the world. Any ifferences, which exist not only in heart failure, but also in any other cardiovascular disorders (8–10), would be acounted for by simple clinical variables. If that were so, and t is not (11,12), then outcomes measured as mortality, orbidity, use of procedures, or hospitalization would be niversally similar, and measurement of those outcomes ould provide an indicator of performance, which would ave validity within regions of a particular country, between ountries, and between continents. What nirvana that ould be for providers of health care. But the reality is therwise.