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9-Year Trend in the Management of Acute Heart Failure in Japan: A Report From the National Consortium of Acute Heart Failure Registries.

ABSTRACT: Background Acute heart failure ( AHF ) is a heterogeneous condition, and its characteristics and management patterns differ by region. Furthermore, limited evidence is available on AHF outside of Western countries. A project by the National Consortium of Acute Heart Failure Registries was designed to evaluate the trends over time in patient backgrounds, in-hospital management patterns, and long-term outcomes of patients with AHF over 9 years in Japan. Methods and Results Between 2007 and 2015, registry data for patients with AHF were collected from 3 large-scale quality AHF registries ( ATTEND / WET - HF / REALITY - AHF ). Predefined end points were trends over time in age, sex, and clinical outcomes, including short- and long-term mortality and readmission for heart failure. The final data set consisted of 9075 patients with AHF . No significant differences in patient backgrounds and laboratory findings (eg, anemia or renal function) were observed, with the exception of patient age; mean age became substantially higher over 9 years (71.6-77.0 years; P for trend, <0.001). On the contrary, length of hospital stay became shorter (mean, 26-16 days). These changes were not associated with in-hospital mortality (4.7-7.5%) or 30-day heart failure readmission rate (4.8-5.4%), as well as 1-year mortality and heart failure readmission rate (20.1-23.3% and 23.6-26.2%, respectively). Conclusions Length of hospital stay in patients with AHF shortened over the 9-year period despite the increasing age of the patients. However, short- and long-term outcomes do not seem to be affected; continuous efforts to monitor clinical outcomes in patients with AHF are needed.

SUBMITTER: Shiraishi Y

PROVIDER: S-EPMC6222932 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionThis study described patients hospitalized for acute heart failure (AHF) in Japan who received intravenous (IV) diuretics and/or vasodilators as the initial therapy.MethodsThe Japan Medical Data Vision database was used to identify adult patients hospitalized for AHF during 2013-2017, who were hemodynamically stable at presentation and treated with IV diuretics and/or IV vasodilators as initial therapy. Treatment patterns and use of cardiac rehabilitation, as well as outcomes (e.g., length of stay [LOS], in-hospital mortality, HF-readmission) were reported overall and by year of AHF hospitalization.ResultsOf 30,360 patients (mean age = 80.0 years; 52.2% male), 87.0% were treated during the hospitalization with IV diuretics, 63.9% with IV vasodilators, and 13.8% with intensified therapies. On average, the duration of IV therapy was 10.6 days. In-hospital cardiac rehabilitation was utilized by 51.7% of the patients for 11.7 days on average. Mean LOS was 23.3 days, while in-hospital mortality and 30-day HF readmission post-discharge were 13.2 and 9.5%, respectively. Hospitalization outcomes remained stable between 2013 and 2017 despite important changes in AHF management such as a decrease in carperitide use (55.9-40.0% in 2017), and increases in use of tolvaptan (from 14.2% in 2013 to 31.3% in 2017) and of cardiac rehabilitation (from 43.2% in 2013 to 56.1% in 2017). Patients with intensified therapies had the longest IV therapy duration (mean 23.8 days vs. 5.5-9.9 days), the highest cardiac rehabilitation services use (60.2 vs. 38.3-57.0%), the longest LOS (mean 36.7 vs. 16.3-22.2 days), and the highest in-hospital mortality (37.4 vs. 3.1-12.4%) compared to the other treatment groups.ConclusionsContemporary treatment for AHF hospitalization in Japan comprises a long duration of IV therapy followed by extended use of oral medications and in-hospital cardiac rehabilitation prior to discharge. Patients requiring intensified therapies had much longer LOS and higher in-hospital mortality.

Project description:Importance:Hospitals in the United States have been subject to mandatory public reporting of mortality rates for acute myocardial infarction (AMI) and heart failure (HF) since 2007 and to value-based payment programs for these conditions since 2011. However, whether hospitals with initially poor baseline performance have improved relative to other hospitals under these programs, and whether patterns of improvement differ by condition, is unknown. Understanding trends within public reporting and value-based payment can inform future efforts in these areas. Objective:To examine patterns in 30-day mortality from AMI and HF and determine whether they differ for baseline poor performers (worst quartile in 2009 and 2010 in public reporting, prior to value-based payment) compared with other hospitals. Design, Setting, and Participants:Retrospective cross-sectional study at US acute care hospitals from 2009 to 2015 that included 2751 and 3796 hospitals with publicly reported mortality data for AMI and HF, respectively. Exposures:Public reporting and value-based purchasing. Main Outcomes and Measures:Hospital-level risk-adjusted 30-day mortality rates. Results:We identified 422 and 600 baseline poor-performing hospitals for AMI and HF, respectively. Baseline poor performers for AMI were more often public and for-profit and less often teaching hospitals. Baseline poor performers for HF were less often large hospitals. For AMI, 30-day mortality among baseline poor performers was higher at baseline but improved more over time compared with other hospitals (18.6% in 2009 to 14.6% in 2015; -0.74% per year; P?<?.001 vs 15.7% in 2009 to 14.0% in 2015; -0.26% per year; P?<?.001; P for interaction <.001). In contrast, for HF, baseline poor performers improved over time (13.5%-13.0%; -0.12% per year; P?<?.001), but mean mortality among all other HF hospitals increased during the study period (10.9%-12.0%; 0.17% per year; P?<?.001; P for interaction, <.001). Conclusions and Relevance:Despite being subject to identical policy pressures, mortality trends for AMI and HF differed markedly between 2009 and 2015.

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9-Year Trend in the Management of Acute Heart Failure in Japan: A Report From the National Consortium of Acute Heart Failure Registries.

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