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Takabayashi K, Kitaguchi S, Yamamoto T, Fujita R, Takenaka K, Takenaka H, Okuda M, Nakajima O, Koito H, Terasaki Y, Kitamura T, Nohara R. Association Between Physical Status and the Effects of Combination Therapy With Renin-Angiotensin System Inhibitors and β-Blockers in Patients With Acute Heart Failure. Circ Rep 2021; 3:217-226. [PMID: 33842727 PMCID: PMC8024019 DOI: 10.1253/circrep.cr-20-0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background:
This study investigated whether combination therapy (CT) with renin-angiotensin system inhibitors and β-blockers improved endpoints in acute heart failure (AHF). Methods and Results:
AHF patients were recruited to this prospective multicenter cohort study between April 2015 and August 2017. Patients were divided into 3 categories based on ejection fraction (EF), namely heart failure (HF) with reduced EF (HFrEF), HF with midrange EF (HFmrEF), and HF with preserved EF (HFpEF), and a further into 2 groups according to physical status (those who could walk independently outdoors and those who could not). The composite endpoint included all-cause mortality and hospitalization for HF. Data at the 1-year follow-up were available for 1,018 patients. The incidence of the composite endpoint was significantly lower in the CT than non-CT group for HFrEF patients, but not among HFmrEF and HFpEF patients. For patients who could walk independently outdoors, a significantly lower rate of the composite endpoint was recorded only in the HFrEF group. The differences were maintained even after adjustment for comorbidities and prescriptions, with hazard ratios (95% confidence intervals) of 0.39 (0.20–0.76) and 0.48 (0.22–0.99), respectively. Conclusions:
In this study, CT was associated with the prevention of adverse outcomes in patients with HFrEF. Moreover, CT prevented adverse events only among patients without a physical disorder, not among those with a physical disorder.
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Affiliation(s)
| | | | | | - Ryoko Fujita
- Department of Cardiology, Hirakata Kohsai Hospital Osaka Japan
| | - Kotoe Takenaka
- Department of Cardiology, Hirakata Kohsai Hospital Osaka Japan
| | | | - Miyuki Okuda
- Department of Internal Medicine, Osaka Hospital Osaka Japan
| | - Osamu Nakajima
- Department of Cardiology, Hirakata City Hospital Osaka Japan
| | - Hitoshi Koito
- Department of Cardiology, Otokoyama Hospital Kyoto Japan
| | - Yuka Terasaki
- Department of Internal Medicine, Arisawa General Hospital Osaka Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University Osaka Japan
| | - Ryuji Nohara
- Department of Cardiology, Hirakata Kohsai Hospital Osaka Japan
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Wilton SB, Kaul P, Islam S, Atzema CL, Cruz J, MacFarlane K, McKelvie R, Poon S, Lambert L, Rush K, Deyell M, Wyse DG, Cox JL, Skanes A, Sandhu RK. Surveillance for Outcomes Selected as Atrial Fibrillation Quality Indicators in Canada: 10-Year Trends in Stroke, Major Bleeding, and Heart Failure. CJC Open 2021; 3:609-618. [PMID: 34036258 PMCID: PMC8134946 DOI: 10.1016/j.cjco.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background Whether advances in identification and management of atrial fibrillation and atrial flutter (collectively, AF) have led to improved outcomes is unclear. We sought to study trends in clinical outcomes selected as quality indicators for nonvalvular AF in Canada. Methods We identified hospitalized patients with a first diagnosis of nonvalvular AF between April 2006 and March 2015, in all of Canada except Quebec. We assessed trends in 1-year incidence of stroke/systemic embolism (SSE), major bleeding, and initial heart failure (HF) hospitalization. Results The cohort included 466,476 patients. The median age was 77 years (interquartile range, 68-84 years), 46% were female, and 68% had a Congestive Heart Failure, Hypertension, Age (≥75 years), Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age (65-74 years), Sex (Female) (CHA2DS2-VASc) score > 3. Within 1 year of discharge, 3.5% were hospitalized for stroke or SSE, 1.6% for major bleeding, and 8.6% for new HF. Over the study period, the crude rate of SSE declined from 3.6% to 3.3% (P = 0.002), whereas the rates of hospitalization for new HF and for major bleeding did not significantly change. After adjustment for CHA2DS2-VASc score, the yearly rates of incident SSE (risk ratio, 0.99; 95% confidence interval [CI], 0.98-0.99; P = 0.002) and HF (risk ratio, 0.99; 95% CI, 0.99-1.00; P = 0.001) declined ≤ 1% absolute, whereas major bleeding remained unchanged (risk ratio, 1.00; 95% CI, 0.99-1.00; P = 0.28). Conclusions Among hospitalized patients with nonvalvular AF in Canada, the rate of SSE and new HF decreased modestly over a 10-year period, with no significant change in major bleeding. Efforts to study process-based quality indicators, with increased focus on HF prevention, are needed.
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Affiliation(s)
- Stephen B Wilton
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Padma Kaul
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Sunjidatul Islam
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Clare L Atzema
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jennifer Cruz
- Cardiac Arrhythmia Service, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Robert McKelvie
- Division of Cardiology, Western University, London, Ontario, Canada
| | - Stephanie Poon
- Division of Cardiology, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Laurie Lambert
- Institut national d'excellence en santé et en services sociaux, Montreal, Quebec, Canada
| | - Kathy Rush
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada.,Departments of Medicine and of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marc Deyell
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - D George Wyse
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jafna L Cox
- Departments of Medicine and of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Allan Skanes
- Department of Medicine, London Heart Institute, University of Western Ontario, London, Ontario, Canada
| | - Roopinder K Sandhu
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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Takabayashi K, Kitaguchi S, Iwatsu K, Ikeda T, Fujita R, Okuda M, Nakajima O, Koito H, Terasaki Y, Kitamura T, Nohara R. Living Alone and Gender Differences in Rehospitalization for Heart Failure After Discharge Among Acute Heart Failure Patients. Int Heart J 2020; 61:1245-1252. [PMID: 33191359 DOI: 10.1536/ihj.20-386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Home treatment for heart failure (HF) is one of the most important problems in patients after discharge as a secondary preventive measure for rehospitalization for HF. However, there are no detailed studies on gender differences in sociopsychological factors such as living alone for HF rehospitalization among patients with acute HF (AHF).This prospective multicenter cohort study enrolled patients with AHF between April 2015 and August 2017. Patients of each gender with first AHF were divided into those living alone and those not living alone. The primary endpoint was defined as rehospitalization for HF after discharge. Cox proportional hazard analysis was performed to determine the association between living alone and the endpoint.Overall, 581 patients were included in this study during the 3-year follow-up. The proportion of rehospitalization for HF was significantly higher in patients living alone than in those not living alone among male patients. However, female patients showed no difference in endpoints between the two groups. The difference was independently maintained even after adjusting for differences in social backgrounds in male patients (adjusted hazard ratio (HR) 2.02; 95% confidence interval (CI), 1.07-3.70). In female patients, the HR for rehospitalization for HF showed no difference between the two groups (adjusted HR, 0.99; 95% CI, 0.56-1.69).In this study population, male patients living alone after first AHF discharge had a higher risk of rehospitalization for HF than those not living alone, but these differences were not observed in female patients.
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Affiliation(s)
| | | | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | - Tsutomu Ikeda
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | - Ryoko Fujita
- Department of Cardiology, Hirakata Kohsai Hospital
| | - Miyuki Okuda
- Department of Cardiology, Hirakata Kohsai Hospital
| | | | | | - Yuka Terasaki
- Department of Internal Medicine, Arisawa General Hospital
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | - Ryuji Nohara
- Department of Cardiology, Hirakata Kohsai Hospital
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Takabayashi K, Fujita R, Iwatsu K, Ikeda T, Morikami Y, Ichinohe T, Yamamoto T, Takenaka K, Okuda M, Nakajima O, Koito H, Terasaki Y, Kitamura T, Kitaguchi S, Nohara R. Impact of home‐ and community‐based services in the long‐term care insurance system on outcomes of patients with acute heart failure: Insights from the
Kitakawachi Clinical Background and Outcome of Heart Failure Registry. Geriatr Gerontol Int 2020; 20:967-973. [DOI: 10.1111/ggi.14013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/13/2020] [Accepted: 07/25/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | - Ryoko Fujita
- Department of Cardiology Hirakata Kohsai Hospital Osaka Japan
| | - Kotaro Iwatsu
- Department of Rehabilitation Hirakata Kohsai Hospital Osaka Japan
| | - Tsutomu Ikeda
- Department of Rehabilitation Hirakata Kohsai Hospital Osaka Japan
| | - Yuko Morikami
- Department of Cardiology Hirakata Kohsai Hospital Osaka Japan
| | - Tahei Ichinohe
- Department of Cardiology Hirakata Kohsai Hospital Osaka Japan
| | | | - Kotoe Takenaka
- Department of Cardiology Hirakata Kohsai Hospital Osaka Japan
| | - Miyuki Okuda
- Department of Cardiology Hirakata Kohsai Hospital Osaka Japan
| | - Osamu Nakajima
- Department of Cardiology Hirakata City Hospital Osaka Japan
| | - Hitoshi Koito
- Department of Cardiology Otokoyama Hospital Kyoto Japan
| | - Yuka Terasaki
- Department of Internal medicine Arisawa General Hospital Osaka Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine Graduate School of Medicine, Osaka University Osaka Japan
| | | | - Ryuji Nohara
- Department of Cardiology Hirakata Kohsai Hospital Osaka Japan
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Takabayashi K, Terasaki Y, Okuda M, Nakajima O, Koito H, Kitamura T, Kitaguchi S, Nohara R. The clinical characteristics and outcomes of heart failure patient with chronic obstructive pulmonary disease from the Japanese community-based registry. Heart Vessels 2020; 36:223-234. [PMID: 32770265 DOI: 10.1007/s00380-020-01675-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/31/2020] [Indexed: 12/30/2022]
Abstract
Both heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common diseases, but few studies have assessed the relationship between COPD and outcomes in patients with acute HF, especially in relation to age or ejection fraction (EF). The Kitakawachi Clinical Background and Outcome of Heart Failure Registry was a prospective, multicenter, community-based cohort and enrolled a total of 1,102 patients with acute HF between 2015 and 2017 in this study. The primary endpoint was defined as a composite endpoint that included all-cause mortality and hospitalization for HF. We stratified patients into two groups: those aged ≥ 80 years (elderly) and < 80 years (nonelderly). HF with preserved EF (HFpEF) was defined as EF ≥ 50%, whereas HF with reduced ejection fraction (HFrEF) was defined as EF < 50%. A total of 159 patients (14.4%) with COPD and 943 patients (83.6%) without COPD were included. COPD was found to be independently associated with a higher risk of the composite endpoint (adjusted hazard ratio: 1.42, 95% confidence interval: 1.14-1.77; p = 0.003). During a subgroup analysis, COPD was exposed as an independent risk factor of the composite endpoint in nonelderly patients; however, there was not such a finding observed among elderly patients. Separately, there was a significant association with COPD and the composite endpoint in patients with HFpEF. COPD showed a significantly higher risk of the composite endpoint after discharge in acute HF. However, this heightened risk was observable only in the subgroup of nonelderly patients and those of HFpEF.
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Affiliation(s)
- Kensuke Takabayashi
- Department of Cardiology, Hirakata Kohsai Hospital, 1-2-1, Fujisakahigashimachi, Hirakata, Osaka, 573-0153, Japan.
| | - Yuka Terasaki
- Department of Internal Medicine, Arisawa General Hospital, Osaka, Japan
| | - Miyuki Okuda
- Department of Cardiology, Hirakata Kohsai Hospital, 1-2-1, Fujisakahigashimachi, Hirakata, Osaka, 573-0153, Japan
| | - Osamu Nakajima
- Department of Cardiology, Hirakata City Hospital, Osaka, Japan
| | - Hitoshi Koito
- Department of Cardiology, Otokoyama Hospital, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shouji Kitaguchi
- Department of Cardiology, Hirakata Kohsai Hospital, 1-2-1, Fujisakahigashimachi, Hirakata, Osaka, 573-0153, Japan
| | - Ryuji Nohara
- Department of Cardiology, Hirakata Kohsai Hospital, 1-2-1, Fujisakahigashimachi, Hirakata, Osaka, 573-0153, Japan
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Takabayashi K, Iwatsu K, Ikeda T, Morikami Y, Ichinohe T, Yamamoto T, Takenaka K, Takenaka H, Muranaka H, Fujita R, Okuda M, Nakajima O, Koito H, Terasaki Y, Kitamura T, Kitaguchi S, Nohara R. Clinical Characteristics and Outcomes of Heart Failure Patients With Long-Term Care Insurance - Insights From the Kitakawachi Clinical Background and Outcome of Heart Failure Registry. Circ J 2020; 84:1528-1535. [PMID: 32713877 DOI: 10.1253/circj.cj-20-0017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In Japan, the long-term care insurance (LTCI) system has an important role in helping elderly people, but there have been no clinical studies that have examined the relationship between the LTCI and prognosis for patients with acute heart failure (HF).Methods and Results:This registry was a prospective multicenter cohort, 1,253 patients were enrolled and 965 patients with acute HF aged ≥65 years were comprised the study group. The composite endpoint included all-cause death and hospitalization for HF after discharge. We divided the patients into 4 groups: (i) patients without LTCI, (ii) patients requiring support level 1 or 2, (iii) patients with care level 1 or 2, and (iv) patients with care levels 3-5. The Kaplan-Meier analysis identified a lower rate of the composite endpoint in group (i) than in the other groups. After adjusting for potentially confounding effects using a Cox proportional regression model, the hazard ratio (HR) of the composite endpoint increased significantly in groups (iii) and (iv) (adjusted HR, 1.62; 95% confidence interval [CI], 1.22-1.98 and adjusted HR, 1.62; 95% CI, 1.23-2.14, respectively) when compared with group (i). However, there was no significant difference between groups (i) and (ii). CONCLUSIONS The level of LTCI was associated with a higher risk of the composite endpoint after discharge in acute HF patients.
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Affiliation(s)
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | - Tsutomu Ikeda
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | | | | | | | | | | | | | - Ryoko Fujita
- Department of Cardiology, Hirakata Kohsai Hospital
| | - Miyuki Okuda
- Department of Cardiology, Hirakata Kohsai Hospital
| | | | | | - Yuka Terasaki
- Department of Internal Medicine, Arisawa General Hospital
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | | | - Ryuji Nohara
- Department of Cardiology, Hirakata Kohsai Hospital
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