Abstract
BackgroundThis study aimed to collect data on “triple therapy” for heart failure (HF) with angiotensin-converting enzyme inhibitors (or receptor blockers), β-blockers, and mineralocorticoid receptor antagonists in all eight regions of Japan and clarify the reason for the selection of this therapeutic approach.Methods and resultsWe used data from April 2017 to March 2018 from the Medical Data Vision database (380 facilities) to analyze factors impacting triple therapy for HF. Among patients who were hospitalized for HF during the study period, 51,933 patients met the inclusion criteria and underwent further analyses. A reference value of 20.45% from Kanto was used to compare the eight Japanese regions.From the patient cohort, 10,006 (19.27%) patients receiving triple therapy were identified.The highest and lowest rates of triple therapy were in Chugoku (21.90%) and Shikoku (14.27%), respectively, suggesting regional differences in the use of triple therapy at discharge for patients with HF (P < 0.001). Regression analysis revealed a decrease in the administration of triple therapy for patients with chronic kidney disease (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.43–0.48]; P < 0.001), those aged 75 years and older (OR, 0.46, 95% CI: 0.44–0.49; P < 0.001), those from Shikoku (OR, 0.69; 95% CI, 0.60–0.80; P < 0.001), those with chronic obstructive pulmonary disease (OR, 0.75; 95% CI, 0.68–0.84; P < 0.001), those with anemia (OR, 0.78; 95% CI, 0.62–0.98; P = 0.034), and those from Tohoku (OR, 0.83; 95% CI, 0.75–0.92; P < 0.001).ConclusionsFuture efforts to rectify the regional variance in drug therapy conforming to the guidelines for the treatment of acute and chronic HF will help to extend the healthy lifespans of patients with HF. Further clarification is required to determine instances where triple therapy should be avoided based on patient factors, and appropriate countermeasures should be identified.
Highlights
Heart failure (HF) is defined as a “clinical syndrome that involves some form of cardiac dysfunction, that is, where the heart experiences an organic or functional abnormality with a breakdown in the ability to compensate its heart pumping function, resulting in dyspnea, malaise, or edema, and lowering exercise tolerance” [1]
Actual state of "triple therapy" for heart failure patients in eight regions of Japan privileges, and other researchers will be able to access the data in the same manner as the authors
Among hospitalized patients within the aforementioned categories, patients who did not undergo cardiovascular surgery, percutaneous coronary angioplasty, or percutaneous coronary intervention (PCI), who survived until discharge, and had no readmission planned in advance, were included in the database
Summary
Heart failure (HF) is defined as a “clinical syndrome that involves some form of cardiac dysfunction, that is, where the heart experiences an organic or functional abnormality with a breakdown in the ability to compensate its heart pumping function, resulting in dyspnea, malaise, or edema, and lowering exercise tolerance” [1]. Among the deaths from heart disease, 73,545 deaths were due to HF; HF remains a disease with a high mortality rate. To address this situation, Japan passed a “basic law regarding measures against stroke, heart disease, and other cardiovascular diseases in order to lengthen the healthy life expectancy” in December 2018 [4]. Article 11 sets forth: “Prefectural and city governments shall formulate plans for promoting countermeasures against cardiovascular disease in the prefecture/city that are based on the Basic Plan for Promoting Cardiovascular Disease Countermeasures, and that take into account prevention of cardiovascular disease in the prefecture/city, the health of patients with cardiovascular disease, the situation regarding the medical and welfare services provided, and advances in research on cardiovascular disease” [4]. This study aimed to collect data on “triple therapy” for heart failure (HF) with angiotensinconverting enzyme inhibitors (or receptor blockers), β-blockers, and mineralocorticoid receptor antagonists in all eight regions of Japan and clarify the reason for the selection of this therapeutic approach
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