Heart Failure In Japan Research Articles

The Role of Metabolic Components in Heart Failure in Japan

Chronic heart failure (CHF) is a clinical syndrome, where both heart failure with reduced ejection fraction and that with preserved ejection fraction (HFPEF) are involved. Although metabolic syndrome (MetS) is the pathological condition with a clustering of metabolic components and is a well known risk and prognostic factor for ischemic heart disease (IHD), its prevalence and clinical significance remain to be fully elucidated in CHF. In the nationwide large-scale clinical study, we enrolled 3,603 patients with Stage C/D CHF from 6 institutes in Japan.

Use of Carperitide in Patients Admitted with Acutely Decompensated Heart Failure in Japan

Use of Carperitide in Patients Admitted with Acutely Decompensated Heart Failure in Japan

Prospective care of heart failure in Japan: lessons from CHART studies.

There are approximately 23 million patients with heart failure (HF) worldwide. The prognosis of patients with HF is still poor and a prospective approach for preventing and treating HF is necessary. The number of HF patients in Japan has been increasing since 1950 mainly because of a rapidly aging population. Furthermore, westernized dietary pattern, reduced physical activity, and obesity have become prominent, particularly in younger Japanese men. There is an increasing trend of diabetes and dyslipidemia, and the prevalence of smoking and hypertension continues to remain high. One of the largest HF cohorts in Japan, the CHART Studies, showed that coronary artery disease (CAD) was the most frequent etiology of HF currently. Thus, prospective strategies including accurate risk stratification, effective prevention of disease progression through evidence-based treatments, optimally personalized treatment particularly in elderly individuals, and life-long control of CAD risk factors are required to manage HF in Japan.

Sex differences with respect to clinical characteristics, treatment, and long-term outcomes in patients with heart failure

The effect of sex on the etiology, risk factors, comorbidities, treatment and prognosis in patients with heart failure (HF) encountered in routine clinical practice in Asian populations has not been well described. The objective of the present study was to elucidate sex differences with respect to the clinical characteristics, treatment, and prognosis of HF patients treated in routine clinical practice settings using the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) database, which is a nationwide registry for hospitalized patients with HF in Japan. JCARE-CARD enrolled 2675 patients hospitalized for HF at 164 participating hospitals from January 2005 to June 2006. HF was diagnosed by the simultaneous presence of at least two major criteria or onemajor criterion in conjunctionwith twominor criteria by use of the criteria from the Framingham Heart Study [1]. For each patient, baseline data recorded on the form were: demography; HF causes; comorbidities; complications; clinical status; echocardiographic findings; plasma B-type natriuretic peptide (BNP); and treatments. Longterm follow-up data could be obtained from 2305 patients after hospital discharged. Mean post-discharge follow-up was 2.3±0.7 years.

The Largest Cohort Study Opens a New Era for the Management of Heart Failure in Japan

The Largest Cohort Study Opens a New Era for the Management of Heart Failure in Japan

Body Mass Index Is an Independent Predictor of Long-Term Outcomes in Patients Hospitalized With Heart Failure in Japan - A Report From the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) -

Obesity is a risk factor for cardiovascular disease (CVD) and is also associated with an increased risk of death in subjects without CVD. However, in heart failure (HF), elevated body mass index (BMI) has been shown to be associated with better prognosis, but it is unknown whether this is the case in unselected HF patients encountered in routine clinical practice in Japan. The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) studied prospectively the characteristics and treatments in a broad sample of patients hospitalized with worsening HF and the outcomes were followed for 2.1 years. Study cohort (n=2,488) was classified into 3 groups according to baseline BMI: <20.3kg/m(2) (n=829), 20.3-23.49kg/m(2) (n=832), and ≥23.5kg/m(2) (n=827). The mean BMI was 22.3±4.1kg/m(2). Patients with higher BMI had lower rates of all-cause death, cardiac death, and rehospitalization because of worsening HF. After multivariable adjustment, the risk for all-cause death and cardiac death significantly increased with decreased BMI levels compared with patients with BMI ≥23.5kg/m(2). However, BMI levels were not associated with rehospitalization for worsening HF. Lower BMI was independently associated with increased long-term all-cause, as well as cardiac, mortality in patients with HF encountered in routine clinical practice in Japan.

Vasospastic heart failure: Multiple spasm may cause transient heart failure?

There have been no reports concerning the correlation between heart failure and coronary artery spasm. From January 2000 to December 2007, 201 patients with heart failure were hospitalized at our institution. We could perform coronary arteriography and spasm provocation tests in 37 (22 men, 67±11 years) out of 201 patients with heart failure before discharge. Atrial fibrillation was observed in 13 patients (35%). After controlling heart failure and 24h cessation of vasoactive drugs, pharmacological spasm provocation tests were performed. Positive spasm was defined as >90%. Coronary spasm was observed in 12 patients (32%) and multiple spasm was recognized in 10 (83%) out of 12 patients. Though ejection fraction on admission was not different between the two groups (42±18% vs. 43±11%, ns), left ventricular end-diastolic and end-systolic dimension after medical therapy over 1 year was significantly smaller in patients with positive spasm than that in patients with negative spasm. There was no difference concerning medications except the administration of nitrate and nicorandil between two groups. Coronary artery spasm, especially multiple spasm, may cause transient heart failure in a small part of unknown origin heart failure in Japan.

Left ventricular geometry, risk factors, and outcomes of hospitalized patients with diastolic heart failure in Japan

Studies of the characteristics, risk factors, prognostic factors, and outcomes of diastolic heart failure (DHF) have yielded inconsistent findings. Moreover, few epidemiological studies of DHF have been performed in Japan. We studied patients with heart failure who were admitted consecutively to Yokohama City University Hospital from 2000 through 2003. Heart failure with a left ventricular ejection fraction (LVEF) of > or = 50% was classified as DHF (n=67), and that with an LVEF of < or = 35% was classified as systolic heart failure (SHF; n=72). Relative wall thickness (RWT) (0.61 vs. 0.34, p<0.0001) and left ventricular mass index (210.3 vs. 152.1, p<0.0001) were greater in DHF than in SHF. Age (odds ratio [OR]=1.068, 95% CI=1.020-1.119; p=0.006) and RWT (OR=17.945, CI=5.883-54.745; p<0.0001) were positive risk factors for DHF. A history of myocardial infarction was a negative risk factor for DHF (OR=0.053, CI=0.008-0.342; p=0.002). Left ventricular mass index was slightly but not significantly related to DHF (OR=1.010, CI=1.000-1.019; p=0.053). Survival did not differ significantly between patients with DHF and those with SHF. Advancing age and a greater RWT were positive risk factors for DHF. LV geometry of DHF and SHF are quite different. DHF is characterized by concentric hypertrophy of the left ventricle, whereas SHF is characterized by eccentric hypertrophy. Age and RWT were positive risk factors for DHF. Survival is similar in DHF and SHF.

Adherence to self-care behavior and factors related to this behavior among patients with heart failure in Japan

Adherence to self-care behavior is important for patients with heart failure (HF) to prevent exacerbation of HF. The aim of this study was to evaluate adherence, identify associated factors, and clarify the impact of previous HF hospitalizations on adherence in outpatients with HF. A total of 116 outpatients completed a questionnaire, including the Japanese version of the European Heart Failure Self-Care Behavior Scale, to assess adherence. Regardless of previous hospitalizations, adherence to seek help if HF worsened was poor. Multivariate analysis adjusted for age and brain natriuretic peptide showed that diabetes mellitus and being employed were independent predictors of poorer adherence to self-care behavior (P = .03, P = .02, respectively), but the experience of previous HF hospitalizations was not a predictor. Self-care strategies for HF should target patients with diabetes mellitus and employed patients. Further study is necessary to develop effective programs for such patients.

374: Retrospective Review of Japanese Heart Transplant Recipients Transplanted in Japan and Transplanted at UCLA in the U.S.

Heart transplantation (HTx) has not been a major treatment for end-stage heart failure in Japan due to donor shortage and domestic legal issue. To date, 184 Japanese patients underwent HTx so far including 59 recipients transplanted in Japan and 125 recipients transplanted out of Japan.

Effects of Atrial Fibrillation on Long-Term Outcomes in Patients Hospitalized for Heart Failure in Japan A Report From the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)

Atrial fibrillation (AF) is a common arrhythmia in patients with heart failure (HF), but its prognostic importance is controversial. The effect of AF on long-term outcomes, including mortality and rehospitalization, among unselected HF patients hospitalized with HF in routine clinical practice in Japan was assessed in the present study. The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) prospectively studied the characteristics and treatment strategies of a broad sample of patients hospitalized with worsening HF and the outcomes were followed with an average of 2.4 years of follow-up. The study cohort (n=2,659) was grouped according to the presence (n=937; 35.2%) or absence (n=1,722; 64.8%) of AF at baseline. After multivariable adjustment, patients with and without AF had a comparable risk for all-cause death (adjusted hazard ratio (HR) 0.931, 95% confidence interval (CI) 0.690-1.258, P=0.643), cardiac death (adjusted HR 0.949, 95%CI 0.655-1.377, P=0.784), rehospitalization because of the worsening HF (adjusted HR 1.028, 95%CI 0.816-1.295, P=0.816), and all-cause death or rehospitalization (adjusted HR 1.039, 95%CI 0.842-1.281, P=0.722). Among patients hospitalized for HF in Japan, AF was common, but was not an independent risk for long-term adverse outcomes, including death or rehospitalization, in routine clinical practice.

Incidence and Clinical Predictors of Deep Vein Thrombosis in Patients Hospitalized With Heart Failure in Japan

The aim of this study was to clarify the incidence and clinical predictors of deep vein thrombosis (DVT) in patients with congestive heart failure (CHF) in Japan. Between January 2003 and January 2008, 161 patients were admitted to Mie University Hospital with a diagnosis of CHF and underwent venous compression ultrasonography. Of them, 18 patients (11.2%) were diagnosed with DVT. As defined by New York Heart Association (NYHA) functional class, class IV patients had a higher incidence rate of DVT than those in class II or III (class II: 3 patients (4.4%), class III: 2 patients (4.8%), class IV: 13 patients (25.5%), P<0.01). Multiple logistic regression analysis identified that NYHA functional class and poor collapsibility of the inferior vena cava on ultrasonography as independent predictors of DVT (odds ratios (OR) 3.74, 95% confidence interval (CI) 1.72-8.16, P<0.01 and OR 4.43, 95%CI 1.36-14.43, P<0.05, respectively). Therapy without anticoagulation also indicated a significant increase in DVT incidence in CHF patients (OR 3.71, 95%CI 1.13-12.18, P<0.05). Patients with CHF have a high risk for DVT and the risk increases according to NYHA functional class, poor IVC collapsibility or therapy without anticoagulation.

Anemia is an Independent Predictor of Long-Term Adverse Outcomes in Patients Hospitalized With Heart Failure in Japan A Report From the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)

Anemia is common in patients with heart failure (HF) and is associated with worse outcomes. However, the effects of anemia are unknown in an unselected group of HF patients encountered in routine clinical practice in Japan. The impact of anemia on long-term outcomes including mortality and rehospitalization among patients hospitalized with HF was thus assessed. The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) prospectively studied the characteristics and treatments in a broad sample of patients hospitalized with worsening HF and the outcomes were followed. Study cohorts (n=1,960) were classified into 4 groups by discharge hemoglobin quartiles: <10.1 g/dl (n=482), 10.1-11.9 g/dl (n=479), 12.0-13.6 g/dl (n=487), and >or=13.7 g/dl (n=512). Of the total cohort of HF patients, 57% had anemia, defined by using the World Health Organization definition. Patients with lower hemoglobin quartiles had higher rates of all-cause death, cardiac death, and rehospitalization due to worsening HF. After multivariable adjustment, the risk for all-cause death, cardiac death, and rehospitalization significantly increased with low hemoglobin concentrations. Anemia was quite common especially in patients with HF encountered in routine clinical practice in Japan, and lower hemoglobin was independently associated with long-term adverse outcomes in these patients.

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

Impending Epidemic Future Projection of Heart Failure in Japan to the Year 2055

The future burden of heart failure in Japan was projected to 2055 in order to prospectively estimate of the number of these patients. The statistics are based on prevalence data of left ventricular dysfunction (LVD) in Sado City using the Sado Heart Failure Study (2003) and population estimates from the Japanese National Institute of Population and Social Security Research Report (2006). The number of Japanese outpatients with LVD was 979,000 in 2005, and is predicted to increase gradually as the population ages, reaching 1.3 million by 2030. LVD is expected to precipitate a future epidemic of heart failure in Japan.

Clinical Characteristics and Outcome of Hospitalized Patients With Congestive Heart Failure

Heart failure (HF) represents a major public health issue in an aging population. Although HF is a leading cause of morbidity and mortality in developed countries, the clinical features of HF in Japan remain unclear. This observational cohort study analyzed data from the Heart Institute of Japan--Department of Cardiology (HIJC)-HF Registry, which is based on a nationwide survey by the HIJC, Tokyo Women's Medical University and its affiliated hospitals. Of 3,578 consecutive patients (average age, 69.8 years; females 40.7%) hospitalized for HF between January 2001 and December 2002, 95.0% were followed up until the end of 2005 (median, 2.8 years). The 1- and 3-year mortality rates were 11.3% and 29.2%, respectively. Multivariate analysis revealed that advanced age (hazard ratio 1.71 [95% confidence interval 1.38-2.12]; p<0.001), symptomatic HF at hospital discharge (3.76 [2.30-6.17]; p<0.001), renal impairment (1.96 [1.50-2.57]; p=0.008), anemia (1.46 [1.18-1.80]; p=0.02) and low pulse pressure (2.88 [1.62-5.13]; p=0.0003) were significantly associated with total death. Although the long-term mortality rate for Japanese patients with HF is lower than in other countries, several markers are modifiable. The data demonstrate that continued improvements in the treatment of Japanese patients with HF are still needed.

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.

Effects of Carperitide and Nicorandil on Injury and Function in Patients with Acute MI: Results of the J-WIND Trial

The results of the Japanese Working Groups of Acute Myocardial Infarction for the Reduction of Necrotic Damage by Atrial Natriuretic Peptide (ANP) or Nicorandil [J-WIND] trials conducted in Japan from 2001–2006. Carperitide, human recombinant ANP, is approved for the treatment of acute heart failure in Japan. Nicorandil, a nicotinamide nitrate that activates potassium channels in the heart, is used to treat chronic angina. These randomized, double-blind studies evaluated intervention with either carperitide or nicorandil on infarct size, left ventricular function, and associated outcomes.