Changes in characteristics and outcomes in Japanese patients with heart failure from the 2000s to the 2010s: The HIJ-HF cohorts

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BackgroundThe number of hospitalized patients with heart failure (HF) is increasing as a result of the increase in the elderly population in Japan. We evaluated changes in the characteristics and outcomes of HF patients hospitalized in the 2000s to the 2010s and discharged alive based on left ventricular ejection fraction (LVEF). MethodsPooled patient data were obtained from The Heart Institute of Japan Heart Failure studies (HIJ-HF I: 2001-2 and HIJ-HF II: 2013–4). We studied patients discharged alive from pooled data based on LVEF < 40% (HFrEF), 40–49% (HFmrEF), and ≥50% (HFpEF). The primary outcome was death from any cause, and the secondary outcomes were cardiac death and rehospitalization due to worsened HF. ResultsThe proportion of HFpEF increased (35%–43%, p < 0.01), and the median ages of patients with HFmrEF (72–76 years, p < 0.01) or HFpEF (72–80 years, p < 0.01) increased from HIJ-HF I to HIJ-HF II. The use of angiotensin II receptor blockers, beta-blockers, statins, amiodarone, and erythropoietin increased, but nitrate and digoxin usage decreased. The adjusted survival rate and cardiac death-free rate were not significantly different between the 2000s and 2010s in any LVEF group, and the incidence of rehospitalization due to worsened HF was reduced in patients discharged alive from HIJ-HF I to HIJ-HF II [HFrEF: hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.51–0.89; HFmrEF: HR 0.89, 95% CI 0.68–1.16; and HFpEF: HR 0.77, 95% CI 0.61–0.97] with no significant interaction by LVEF groups. ConclusionOur study demonstrated that age, the proportion of HFpEF, and guideline-recommended drug therapy use increased among hospitalized Japanese HF patients from the 2000s to the 2010s. The adjusted survival rate was not improved in any LVEF group, although the incidence of rehospitalization due to worsened HF was reduced.