Disease Management and Outcomes in Patients Hospitalized for Acute Heart Failure in Japan

Abstract

Introduction: This study described patients hospitalized for acute heart failure (AHF) in Japan who received intravenous (IV) diuretics and/or vasodilators as the initial therapy. Methods: The 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, HFreadmission) were reported overall and by year of AHF hospitalization.Results: Of 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. Inhospital 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. Conclusions: Contemporary 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.

Real-World Intravenous Diuretic Use to Treat Congestion in Patients With Heart Failure ― An Observational Study Using a Research Database ―

“…Almost half the patients (45.7%) in the present study were aged ≥85 years; this was an increase compared with DPC data from the Japan Medical Data Vision database reported for 2013–2017, in which 40.8% were aged ≥85 years. 18 In addition, there were no significant differences in the proportions of patients with diabetes and hypertension or in laboratory values between the present study and other domestic Japanese cohorts. 7 , 17 , 19 Factors affecting in-hospital outcomes include hypertension, dyslipidemia, renal function, ADL, the use of inotropic drugs and medical devices after hospitalization, and the use of IV diuretics.…”

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“…Data were collated from the Japan Medical Data Vision (MDV) database from April 2008 to September 2018 (Supplementary Table S1 ). The database contains administrative claims and laboratory data from 376 Japanese diagnosis procedure combination (DPC) hospitals, representing 21.7% of the 1,730 DPC hospitals in Japan, covering approximately 20 million patients in Japan 32 . In this database, data were classified using the International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes; disease names are coded using Japanese-specific disease codes, and procedures and drug prescriptions and administration are coded using Japanese-specific receipt codes 32 .…”

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“…Data recorded in the MDV database include International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes, disease names coded using Japanese-specific disease codes and procedures, and drug prescriptions and administration codes using Japanese-specific receipt codes. In-hospital mortality information is available in the electronic medical records (EMR) data [ 9 ]. The diagnoses and procedure records of this administrative database have been validated in terms of their accuracy as a substitute for clinical data [ 10 ].…”