Chronic Heart Failure In Japan Research Articles

Impact of treatment of hyperkalaemia on quality of life: design of a prospective observational cohort study of long-term management of hyperkalaemia in patients with chronic kidney disease or chronic heart failure in Japan

IntroductionHyperkalaemia (HK) is a frequent complication in patients with chronic kidney disease (CKD) and/or chronic heart failure (CHF). HK must be managed, both to protect patients from its direct clinical...

Outpatient nursing support for self-monitoring in patients with chronic heart failure.

BackgroundEarly symptoms of worsening heart failure are difficult for patients to detect and manage, contributing to the high readmission rate for worsening heart failure. Thus, it is important to promote self-monitoring and to support patients in recognizing and interpreting their symptoms. This study aimed to explore the ways in which specialized nurses in the outpatient setting provide support for self-monitoring in patients with chronic heart failure in Japan.MethodsThis exploratory study adopted a qualitative study design. The participants were a convenience sample of five nurses certified in chronic heart failure nursing and one advanced practice nurse certified in chronic care nursing, all with experience in outpatient nursing in Japan. Data were collected from June 2017 to October 2017 through semi-structured one-on-one interviews and were analyzed using an established qualitative inductive method.ResultsThe analysis identified seven themes describing the nursing support provided by the study participants. Among these were three themes describing different forms of direct support for self-monitoring: “Encourage patients to reflect on their own,” “Support touching the body and developing body awareness,” and “Support sharing the task.” Two themes described practice perspectives: “Support self-monitoring that is not overly sensitive” and “Support connection with the patient’s life.” Two final themes described contextual factors in the outpatient care setting: “Struggling with constraints and powerlessness” and “Building a support system in the outpatient setting.”ConclusionsThe findings provide a practice for nurses promoting self-monitoring in patients with chronic heart failure in the outpatient setting. The study findings inform and provide goals for the support of self-monitoring in patients with heart failure and also, suggest the need to establish a strong support system for outpatient care in Japan.

Cardiovascular reactions for whole-body thermal therapy with a hot pack and Waon therapy

Background Waon therapy (WT) is the predominant thermal therapy for chronic heart failure in Japan, involving use of a far-infrared dry sauna. As sauna therapy requires certain equipment not readily available in hospitals, we tested the use of whole-body hot pack thermal therapy (HPTT). We compared the magnitude of skin vasodilation post-HPTT with that post-WT. Methods We recruited 19 healthy men (age [mean ± S.D.]: 26.8 ± 4.6 years) and employed a simple randomized crossover design. The HPTT required subjects to remain in a supine position on a bed for at least 10 min. Hot packs were then applied on the back, lower abdomen, and popliteal regions for 15 min (warming phase). Participants continued bed rest for 30 min (heat-retention phase) after removal of the hot pack. WT was performed as previously described. Blood pressure (BP), heart rate (HR), tympanic temperature (TT), and peak and average flow velocity of the right radial artery (PFV and AFV, respectively) and right brachial artery (BA) diameter were measured during HPTT and WT. Results HR, TT, PFV, and AFV persistently and significantly increased during warming and heat-retention phases of HPTT. In WT, HR and TT significantly increased during warming but decreased and plateaued during heat-retention. BP did not change significantly after either therapy; however, BA was dilated equally in both (HPTT: 3.70 ± 0.57 ⇒ 4.05 ± 0.59 mm, p = .001; WT: 3.63 ± 0.63 ⇒ 3.93 ± 0.61 mm, p < .001). Conclusion HPTT may be equivalent to WT with respect to vasodilation response of the skin.

Impact of Physical Activity on Cardiovascular Events in Patients With Chronic Heart Failure

We have previously demonstrated that the prevalence of metabolic syndrome in chronic heart failure (CHF) is more than double compared with the general population in Japan. However, the impact of physical activity on cardiovascular events in CHF patients remains to be fully elucidated. We performed a prospective, nationwide large-scale multicenter study of 9,178 patients with stage A/B/C/D CHF in Japan. We obtained the baseline physical activity data for 7,292 and yearly changes in physical activity data during a 3-year follow-up period for 4,353 patients. We divided the patients into high- and low-exercise groups by using the median value of physical activity in the stage A/B and C/D groups. In both groups, patients who exercised more were characterized by younger age and less advanced stage of CHF. Importantly, the baseline physical activity levels were significantly associated with all-cause death, heart failure (HF) hospitalization and other cardiovascular events (except acute myocardial infarction, stroke, HF hospitalization). Furthermore, the yearly change in physical activity level was also significantly associated with HF hospitalization and other cardiovascular events in both groups. The baseline level of physical activity and its yearly changes are significantly associated with all-cause death and major cardiovascular events in both stage A/B and C/D patients, suggesting that physical activity could be an important therapeutic target to improve the long-term prognosis of CHF patients.

Effectiveness of an educational self‐management program for outpatients with chronic heart failure

The occurrence rate of chronic heart failure (CHF) in Japan is estimated to be 50,000 per one million persons. It is important for the Japanese medical financial system to institute a program of disease management in order to prevent the deterioration of persons with CHF. However, there are still few studies on the disease management of CHF in Japan. Therefore, the purpose of this study was to provide an educational self-management program to Japanese outpatients with CHF in order to improve their clinical outcomes. A randomized, controlled trial with 102 outpatients with CHF was conducted. There were 50 participants in the intervention group and 52 participants in the control group. The control group received medical treatment and standard care. In addition to this, the intervention group also received an educational program for 6 months. The program consisted of six nurse-directed sessions that were provided to each outpatient once per month in a clinical setting for a total of 6 months. A follow-up session was conducted each month for 6 months. The data collection was carried out at the start of the program and at 3, 6, 9, and 12 months. Significant differences could be observed in the primary and secondary outcomes and in the process indicators between the two groups after the program began. In other words, all the indicators improved for the intervention group, compared to the control group. Therefore, this program was considered to be effective. Further long-term care is necessary for outpatients with CHF in order to prevent their deterioration and to maintain their health status, even though this 6 month program did provide them with proper knowledge regarding self-care for CHF and affected their therapy results.

The CHART Study and SUPPORT Trial – One of Realistic Solutions to Fight Chronic Heart Failure in Japan-

The CHART Study and SUPPORT Trial – One of Realistic Solutions to Fight Chronic Heart Failure in Japan-

Chronic heart failure in Japan: Implications of the CHART studies

Chronic heart failure in Japan: Implications of the CHART studies

Chronic heart failure in Japan: Implications of the CHART studies

The prognosis of patients with chronic heart failure (CHF) still remains poor, despite the recent advances in medical and surgical treatment. Furthermore, CHF is a major public health problem in most industrialized countries where the elderly population is rapidly increasing. Although the prevalence and mortality of CHF used to be relatively low in Japan, the disorder has been markedly increasing due to the rapid aging of the society and the Westernization of lifestyle that facilitates the development of coronary artery disease. The Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART)-1 study was one of the largest cohorts in Japan. The study has clarified the characteristics and prognosis of Japanese patients with CHF, demonstrating that their prognosis was similarly poor compared with those in Western countries. However, we still need evidence for the prevention and treatment of CHF based on the large cohort studies or randomized treatment trials in the Japanese population. Since the strategy for CHF management is now changing from treatment to prevention, a larger-size prospective cohort, called the CHART-2 study, has been initiated to evaluate the risk factors of CHF in Japan. This review summarizes the current status of CHF studies in Japan and discusses their future perspectives.

Clinical Impact of Adherence to Guidelines on the Outcome of Chronic Heart Failure in Japan

The impact of guideline adherence on clinical outcomes in the management of chronic heart failure (CHF) has never been evaluated in Japan. We investigated outcomes in 92 consecutive CHF patients admitted to Kitasato University Hospital in 2004-2006 for HF exacerbation with a left ventricular ejection fraction < or = 40% by the use of class I drugs for pump-failure, as recommended in the Japanese Circulation Society guideline. Drugs, namely angiotensin-converting enzyme inhibitors (ACEI), beta-blockers (BB), spironolactone, diuretics, and cardiac glycosides were administered to 64.1%, 59.8%, 28.2%, 96.7%, and 68.0% of patients, respectively. Patients for whom adherence to the prescription of ACEI and BB as first-line agents was high had significantly and independently better prognostic outcomes for cardiac events (P = 0.0036) as well as subsequent improvements in clinical surrogate markers for HF status such as NYHA class and BNP. Addition of the 3 latter drugs to the prescription of ACEI and BB did not affect the superiority of ACE plus BB in improving the long-term prognosis. We have demonstrated that adherence to treatment guidelines for CHF is a significant predictor of subsequent cardiac events in actual practice in Japan. An effective means of improving adherence to current guideline standards of care for CHF has yet to be established.

Role of Metabolic Syndrome in the Pathogenesis of Chronic Heart Failure

Metabolic syndrome (MetS) has recently attracted much attention as a leading cause of cardiovascular diseases, including chronic heart failure (CHF). MetS is associated with visceral obesity, characterized by insulin resistance, dyslipidemia, enhanced thrombogenicity, and inflammatory state. In the pathogenesis of CHF, the role of MetS should be considered from two points; the initiation and the progression of CHF. In the initiation of CHF, MetS causes both diastolic and systolic cardiac dysfunction through cardiac hypertrophy and myocardial infarction/damage, respectively, where activated renin-angiotensin system, enhanced production of inflammatory cytokines and endothelial dysfunction are all involved. We are now conducting a nationwide clinical study to elucidate the role of MetS in the initiation of CHF in Japan. In the progression of CHF, the results of our CHART-1 study (n = 1,278) have demonstrated that MetS is an independent prognostic factor in CHF and that the combination of obesity, diabetes mellitus, and hypertension results in the worse outcome. We are now conducting CHART-2 study (n = 10,000) to further characterize the pathogenesis of CHF in Japan. Our clinical studies should enable us to better understand the pathogenetic role of MetS in CHF.

National Registry of Patients with Chronic Heart Failure in Japan -JCARE study-

National Registry of Patients with Chronic Heart Failure in Japan -JCARE study-

Nationwide Registry of Patients with Chronic Heart Failure in Japan — JCARE study —

Nationwide Registry of Patients with Chronic Heart Failure in Japan — JCARE study —