Nationwide Temporal Trends in Clinical Characteristics and Treatment of Dilated Cardiomyopathy From 2003 to 2013 in Japan　― A Report From Clinical Personal Records ―

Abstract

antagonists (MRAs) are standard drugs used in treatment. The underuse of OMT is related to poor morbidity and mortality in HFrEF. 9,10 In 2002, a Japanese national survey showed that the prescription rates of β-blockers and ACEi for DCM were 41% and 65%, respectively, 11,12 indicating that OMT for DCM was insufficient in Japan. Subsequent studies reported on the implementation of OMT in HF has been reported in Japan. 4, 13 Regarding DCM, a previous study reported temporal trends in the clinical features of and implementation of OMT for DCM patients by analyzing databases of the Chronic Heart Failure Analysis and Registry in Tohoku Distinct-1 Study (CHART-1 study;2000-2005 and CHART-2 study (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). 14 However, the number of DCM patients in these studies was relatively small (CHART-1: 306 patients; CHART-2: 710 patients). Furthermore, they are regional D ilated cardiomyopathy (DCM) is defined as left ventricular (LV) systolic dysfunction and dilation in the absence of coronary artery disease or abnormal loading conditions sufficient to cause global LV impairment, 1 which is a major cause of heart failure with reduced ejection fraction (HFrEF). In several heart failure (HF) registries, DCM accounts for approximately 15% of the etiology among admitted HF patients, 2-5 and is the primary cause of heart transplantation in Japan. 6 The therapeutic strategy against DCM is based on optimal medical therapy (OMT) for HFrEF. 7 Although, recently, angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 (SGLT2) inhibitors have been recommended for HFrEF, 8 β-blockers, angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARBs), and mineralocorticoid receptor