The use of Kampo medications that may cause heart failure in hospitalized acute heart failure patients in a Japanese hospital.
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ABSTRACT: Background
The use of Kampo medications (Japanese traditional herbal medications) is common in Japan. However, some Kampo medications may cause heart failure. Given that the incidence of heart failure has increased in past decades, investigating the prevalence of the use of Kampo medications that may cause heart failure in patients with acute heart failure is important.Method
A retrospective cross-sectional study was conducted. All 437 consecutive hospitalized patients with acute heart failure from April 2017 to October 2019 were included. The primary outcome was the use of Kampo medications, including ephedra, licorice, aconite, or ginseng, which were defined as those that may cause heart failure. The causality between these medications and the index of acute heart failure was determined by clinical pharmacists based on the Naranjo criteria.Results
The mean patient age was 81.1 years old, and 199 (54.5%) were women. Kampo medications that may cause heart failure were used in 30 patients (6.9%), and in four of these patients, acute heart failure was judged to be caused by Kampo medications. In the multivariable analysis, the number of non-Kampo medications used regularly (OR 1.13) and female sex (OR 2.23) were the only independent predictive factors for the use of Kampo medications that may cause heart failure.Conclusions
A substantial proportion of acute heart failure patients in Japanese hospitals use Kampo medications that may cause heart failure. Further study is warranted to investigate the causal link between the incidence of acute heart failure and the use of these herbal medications.
SUBMITTER: Komagamine J
PROVIDER: S-EPMC8090841 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The beta blockers carvedilol, bisoprolol, and sustained-release metoprolol succinate reduce readmissions and mortality among patients with heart failure with reduced ejection fraction (HFrEF), based upon clinical trial and registry studies. Results from these studies may not generalize to the typical patient with HFrEF. We conducted a retrospective cohort study of beneficiaries in the Medicare 5% sample hospitalized for HFrEF between 2007 and 2013 and were discharged alive. We compared the 30-day and 365-day heart failure (HF) readmission, all-cause readmission, and mortality rates between beneficiaries who filled a prescription for an evidence-based beta blocker and those who did not after being hospitalized for HFrEF. Out of 12,127 beneficiaries hospitalized for HFrEF, 20% were readmitted for HF, 62% were readmitted for any cause, and 27% died within 365 days. In competing risk models adjusted for demographics, healthcare utilization, and comorbidities, beta blocker use was associated with a lower risk of HF readmission between 8-365 days post discharge (hazard ratio 0.79 [95% confidence interval 0.76, 0.82]), but was not significantly associated with all-cause readmission (1.02 [0.97-1.07]). In Cox models adjusted for the same covariates, beta blocker use was associated with lower mortality 8-365 days post discharge (0.65 [0.60-0.71]). Results were similar when follow up was truncated at 30 days post discharge. Increasing the use of beta blockers following HFrEF hospitalization may not decrease all-cause readmissions among Medicare beneficiaries, but may reduce HF-specific readmissions and mortality.
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Project description:BackgroundTo achieve the best treatment of heart failure, it is important to use all recommended drugs at their target doses. Given that underuse of medications can occur in individuals with cognitive impairment, we investigated the filled prescriptions and target doses of heart failure medication for older individuals with and without cognitive impairment as well as associated factors.MethodsThe study was based on two separate datasets. The first dataset, which was based on data from questionnaires sent to nursing homes in Sweden, included 405 individuals with heart failure. The data were linked with the Swedish Prescribed Drug Register and the National Patient Register to obtain information regarding filled prescriptions of heart failure medications and heart failure diagnoses among the population. In the second dataset, medical records of individuals aged 75 years or older admitted to a hospital in northern Sweden were reviewed and individuals with heart failure were identified. Target doses of heart failure medications were evaluated in 66 individuals who lived at home.ResultsFilled prescriptions of mineralocorticoid receptor antagonists and loop diuretics were significantly more common in individuals without cognitive impairment (OR 1.087; 95% CI 1.026-1.152, p < 0.05) and (OR 1.057; 95% CI 1.017-1.098, p < 0.05), respectively. There were no significant differences between individuals with and without cognitive impairment in terms of achieving target doses for any of the drug classes. A higher age was associated with fewer filled prescriptions and less ability to reach the target doses of beta blockers (OR 0.950; 95% CI 0.918-0.984, p < 0.05) and (OR 0.781; 95% CI 0.645-0.946, p < 0.05), respectively.ConclusionsOur results suggest that individuals with cognitive impairment are partly undertreated for heart failure in that they had fewer filled prescriptions of important heart medications. Separately, the relatively low proportion of older individuals reaching target doses is an important observation and indicates that treatment of heart failure could be further optimised among older individuals.
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Project description:Background: We sought to explore the effects of previous heart failure (HF) hospitalization on mortality in patients hospitalized for acute decompensated HF (ADHF) in a large Japanese contemporary observational database. Methods and Results: We prospectively enrolled consecutive patients with ADHF in 19 participating hospitals between October 2014 and March 2016. Of 4,056 patients, 1,442 patients (35.4%) had at least 1 previous HF hospitalization (previous hospitalization group), while 2,614 patients (64.5%) did not have a history of HF hospitalization (de novo hospitalization group). Patients with previous hospitalization were older and more often had comorbidities such as anemia, and renal failure than those without. The cumulative 1-year incidence of all-cause death was significantly higher in the previous hospitalization group than in the de novo hospitalization group (28% vs. 19%, P<0.001). After adjusting confounders, the excess risk of the previous hospitalization group relative to the de novo hospitalization group for all-cause death remained significant (HR, 1.28; 95% CI: 1.10-1.50, P=0.001). The excess risk was significant in patients without advanced age, anemia, or renal failure, but not significant in patients with these comorbidities, with significant interaction. Increase in the number of hospitalizations was associated with an increased risk for mortality. Conclusions: In a contemporary ADHF cohort in Japan, repeated hospitalization was associated with an increasing, higher risk for 1-year mortality.
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