Japanese Cardiac Registry Of Heart Failure In Cardiology Research Articles

The Comparison of Clinical Characteristics of Acute Decompensated Heart Failure Patients between JCARE-CARD Japan and dr. Kariadi Hospital Registry

Background: _Heart failure (HF) is a major public health problem due to the high prevalence, poor prognosis, and huge costs contributed by frequent hospital admissions and prolonged care. Clinical characteristics of patients with HF might differ among different regions and races and low socioeconomic status was associated with increased incidence of heart failure. Indonesia dan Japan are both Asian countries with different race and socioeconomic status. No previous study has examined the difference of clinical characteristics between Indonesia dan Japanese HF patients.Objective: To investigate HF patients demographic and clinical characteristics in Indonesia and compare with Japanese registryMethods: In this retrospective observational study, patients presenting with acute decompensated heart failure (ADHF) at dr. Kariadi Hospital (RSDK) were consecutively recruited during 2014-2015 hospitalization period. Baseline data including demographic, clinical characteristics, laboratory data on admission, medication use before hospitalization, and length of stay during hospitalization were collected from medical record using the form of the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). The descriptive analysis was performed to compare those HF characteristics.Results: A total of 246 ADHF patients in RSDK registry were included with average age of responden was 56.4 years-old and 57.3% were male. Etiology was predominantly ischemic heart disease (IHD) in 60.6%, average left ventricular ejection fraction 40.1% and length of hospital stay was 8.8 days. Compared to Japanese registry, the characteristics of clinical status and laboratory data on admission were almost similar between studies except for higher prevalence of ischemic heart disease, renal dysfunction and dyslipidemia but lower prior stroke in RSDK study. The average length of stay at hospital was longer in Japanese registry (8.8 days vs. 33.9 days).Conclusion: Ischaemic heart disease and renal dysfunction more prevalent in RSDK registry, but prior stroke and length of stay at hospital higher in Japanese registry of hospitalized ADHF patients.

Perspective of the β-blockers for the patients with diabetes and heart failure

Patients with diabetes and heart failure have been increasing due to Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) study. β-blockers showed significantly suppressed cardiovascular events in the strict glycemic control group. Sodium-glucose Cotransporter-2 Inhibitors (SGLT2i) seem to be beneficial for diabetes and heart failure. Clinical efficacy of β-blockers would be suggested from three studies including Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME) trial, Canagliflozin cardioVascular Assessment Study (CANVAS) and Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study. Further discussion will be expected with research in detail.

Electrocardiographic Left Ventricular Hypertrophy Is Independently Associated With Better Long-Term Outcomes in Dilated Cardiomyopathy Patients.

Background: Electrocardiogram (ECG) findings of left ventricular hypertrophy (LVH; ECG-LVH) are observed in patients with dilated cardiomyopathy (DCM), but the prognostic importance is unclear. The present study assessed the impact of QRS voltage on long-term outcomes, including mortality and rehospitalization, in patients with DCM using a database of patients hospitalized for worsening heart failure (HF).Methods and Results: We analyzed a total of 261 patients with DCM in the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD), a prospective cohort studying the characteristics and treatments in a broad sample of HF patients. ECG-LVH were diagnosed according to the Sokolow-Lyon voltage criteria. A total of 81 patients (31.0%) had ECG-LVH. During a mean follow-up period of 1.8 years, patients with ECG-LVH had a lower rate of all-cause death (9.0% vs. 20.3%, P=0.029) and composite of all-cause death and rehospitalization due to worsening HF (26.9% vs. 45.9%, P=0.007) than those without it. After multivariable adjustment, ECG-LVH was an independent negative predictor for the risk of composite all-cause death and rehospitalization (hazard ratio, 0.358; 95% CI: 0.157–0.857, P=0.049).Conclusions: ECG-LVH were independently associated with better long-term outcome in patients with DCM.

Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)

Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)

Clinical characteristics and CHADS2 score in patients with heart failure and atrial fibrillation: Insights from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)

classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 2006;113:1807–16. [6] Funabashi N, Asano M, Komuro I. Predictors of non-calcified plaques in the coronary arteries of 242 subjects using multislice computed tomography and logistic regression models. Int J Cardiol 2007;117:191–7. [7] Uehara M, Takaoka H, Kobayashi Y, Funabashi N. Diagnostic accuracy of 320-slice computed-tomography for detection of significant coronary artery stenosis in patients with various heart rates and heart rhythms compared with conventional coronary-angiography. Int J Cardiol 2013;167:809–15. [8] Takaoka H, Funabashi N, UeharaM, Fujimoto Y, Kobayashi Y. Diagnostic accuracy of coronary 320 slice CT angiography using retrospective electrocardiogram gated acquisition compared with virtual prospective electrocardiogram gated acquisition with and without padding. Int J Cardiol 2013;168:2811–5. [9] UeharaM, Funabashi N, Takaoka H, Fujimoto Y, Kuroda N, Kobayashi Y. Detection of luminal stenosis by 320-slice CT in coronary arteries with cross sectional area less than 4 mm confirmed by intravascular ultrasound compared with conventional coronary angiography. Int J Cardiol 2013;168:5457–60. [10] UeharaM, Funabashi N, Takaoka H, Fujimoto Y, Kobayashi Y. False-positive findings in 320-slice cardiac CT for detection of severe coronary stenosis in comparison with invasive coronary angiography indicate poor prognosis for occurrence of MACE. Int J Cardiol 2014;172:235–7. [11] Stevenson WG. Ventricular scars and ventricular tachycardia. Trans Am Clin Climatol Assoc 2009;120:403–12.

Hyponatremia is an independent predictor of adverse clinical outcomes in hospitalized patients due to worsening heart failure

Background and purposeHyponatremia is common and is associated with poor in-hospital outcomes in patients hospitalized with heart failure (HF). However, it is unknown whether hyponatremia is associated with long-term adverse outcomes. The purpose of this study was to clarify the characteristics, clinical status on admission, and management during hospitalization according to the serum sodium concentration on admission, and determine whether hyponatremia was associated with in-hospital as well as long-term outcomes in 1677 patients hospitalized with worsening HF on index hospitalization registered in the database of the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Methods and subjectsWe studied the characteristics and in-hospital treatment in 1659 patients hospitalized with worsening HF by using the JCARE-CARD database. Patients were divided into 2 groups according to serum sodium concentration on admission <135mEq/mL (n=176; 10.6%) or ≥135mEq/mL (n=1483; 89.4%). ResultsThe mean age was 70.7 years and 59.2% were male. Etiology was ischemic in 33.9% and mean left ventricular ejection fraction was 42.4%. After adjustment for covariates, hyponatremia was independently associated with in-hospital death [adjusted odds ratio (OR) 2.453, 95% confidence interval (CI) 1.265–4.755, p=0.008]. It was significantly associated also with adverse long-term (mean 2.1±0.8 years) outcomes including all-cause death (OR 1.952, 95% CI 1.433–2.657), cardiac death (OR 2.053, 95% CI 1.413–2.983), and rehospitalization due to worsening HF (OR 1.488, 95% CI 1.134–1.953). ConclusionsHyponatremia was independently associated with not only in-hospital but also long-term adverse outcomes in patients hospitalized with worsening HF.

Characteristics, management, and outcomes for patients during hospitalization due to worsening heart failure—A report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)

BackgroundThe characteristics, in-hospital management, and outcomes of patients hospitalized with worsening heart failure (HF) have been described by large-scale registries performed mainly in the USA and Europe. However, little information is available in Japan. We thus clarified the characteristics and clinical status as well as in-hospital management and outcomes among patients hospitalized with worsening HF in Japan and compared them with those reported in previous studies. MethodsThe Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) studied prospectively the characteristics and treatments in patients hospitalized with worsening HF. From the total cohort of JCARE-CARD, 1677 patients were randomly selected and their detailed data during acute phase were collected as another registry database in the present study. The characteristics, in-hospital management, and outcomes were analyzed. ResultsThe mean age was 70.7 years and 59.4% were male. Etiology was ischemic in 34.0% and mean left ventricular ejection fraction was 42.5%. Carperitide was highly used as in-hospital management in Japan (33.5%) compared to the use of nesiritide in the USA (8–11%). The use of angiotensin-converting enzyme inhibitors was lower and angiotensin II receptor blockers (ARB) were more commonly used in this study compared to other studies in the USA and Europe. In-hospital crude mortality rate was comparable among studies (4–8%), however, length of stay was longer in Japan (15–20 versus 4–9 days). ConclusionsThe characteristics, clinical status, and laboratory data on admission in patients hospitalized with worsening HF were similar between the present study and previous Japanese and western studies. Management was also similar except for higher use of carperitide and ARB. The most striking difference between Japanese registries and those from the USA and Europe was the longer length of stay.

Weekend versus weekday hospital admission and outcomes during hospitalization for patients due to worsening heart failure: a report from Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)

The day of the week of admission may influence the length of stay and in-hospital death. However, the association between the admission day of the week and in-hospital outcomes has been inconsistent in heart failure (HF) patients among studies reported from Western countries. We thus analyzed this association in HF patients encountered in routine clinical practice in Japan. We studied the characteristics and in-hospital treatment in 1620 patients hospitalized with worsening HF by using the database of the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Patients were divided into two groups according to weekday (n = 1355; 83.6%) or weekend admission (n = 265; 16.4%). The mean age was 70.7 years and 59.4% were male. Etiology was ischemic in 34.0%, and mean left ventricular ejection fraction was 42.5%. Patients admitted on the weekend were significantly older and had more comorbidities, and more severe symptoms and signs of HF on admission. Length of stay was comparable between weekend and weekday admission (35.2 ± 47.0 days vs 33.6 ± 32.0 days, P = 0.591). Crude in-hospital mortality did not differ between patients admitted on the weekend and weekdays (7.5% vs 5.2%, P = 0.136). Even after adjustment for covariates in multivariable modeling with patients admitted on weekday as the reference, in-hospital death was comparable between patients admitted on the weekend and weekdays (adjusted odds ratio 1.125, 95% confidence interval 0.631-2.004, P = 0.691). Among patients hospitalized for worsening HF, admission day of the week did not affect in-hospital death and length of stay.

Clinical characteristics and outcomes of dilated phase of hypertrophic cardiomyopathy: Report from the registry data in Japan

BackgroundA subset of patients with hypertrophic cardiomyopathy (HCM) has been reported to progress into dilated-HCM (D-HCM), characterized by left ventricular (LV) systolic dysfunction and cavity dilatation, resembling idiopathic dilated cardiomyopathy (DCM). We compared the characteristics, treatments, and outcomes in patients with heart failure (HF) due to D-HCM vs. DCM by using national registry data in Japan. Methods and resultsThe Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) is a prospective observational study of patients hospitalized due to worsening HF with an average of 2.2 years of follow-up. Patients with D-HCM (n=41) were more likely to be male, have prior stroke, atrial fibrillation, and sustained ventricular tachycardia or ventricular fibrillation compared with DCM (n=486). Echocardiography demonstrated that D-HCM patients had smaller LV end-systolic diameter, higher ejection fraction, and greater wall thickness. Treatments for HF including angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, β-blocker, and spironolactone were similar between groups except for higher use of amiodarone, warfarin, and implantable cardioverter-defibrillator for D-HCM. Mortality was significantly higher in patients with D-HCM (29.7% vs. 14.4%; p<0.05). Sudden death tended to be higher also in D-HCM (8.1% vs. 2.6%; p=0.06), which, however, did not reach statistical significance. ConclusionsHF patients with D-HCM had higher mortality risk than those with DCM. Effective management strategies are critically needed to be established for D-HCM.

Mode of Death in Patients With Heart Failure and Reduced vs. Preserved Ejection Fraction

The mode of death has not been investigated in the registry data of patients with heart failure and reduced ejection fraction (HFREF) vs. preserved ejection fraction (HFPEF). The aim of the present study was therefore to carry out this comparison. The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) prospectively studied the characteristics and treatments in a broad sample of 2,675 patients hospitalized with worsening HF, and followed them for an average of 2.1 years. This study included 323 patients in whom information on both the mode of death and left ventricular EF on echocardiography could be obtained. The mode of death was cardiovascular (CV) in 63% (including 17% sudden, 36% HF, 3% myocardial infarction, and 3% stroke), non-CV in 23%, and unknown in 14%. The prevalence of CV death including sudden death was high in patients with HFREF compared to HFPEF (68% vs. 58%, P=0.020). HF death, the most common mode of death, was similar between groups (37% vs. 35%, P=0.694). In contrast, non-CV mortality was significantly higher in HFPEF than those with HFREF (28% vs. 18%, P=0.021). In 60-70% of deaths the mode was CV, and HF death was the most common mode of death in either HFREF or HFPEF. The prevalence of sudden death was lower, and that of non-CV death higher, in HFPEF compared with HFREF.

Loop Diuretic Use at Discharge Is Associated With Adverse Outcomes in Hospitalized Patients With Heart Failure

Loop diuretics are commonly used in patients with heart failure (HF) to remove retained fluid and improve symptoms. However, they may potentially worsen outcomes in HF. It remains unknown whether the use of loop diuretics is associated with adverse HF outcomes in routine clinical practice. We thus determined the effects of loop diuretic use at discharge on long-term mortality and rehospitalization among patients hospitalized with HF. The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) prospectively studied the characteristics and treatments of a broad sample of patients hospitalized with worsening HF and followed for 2.1 years. Among a total of 2,549 HF patients, loop diuretics were used by 2,015 patients (79%), but not 534 patients (21%). The mean age was 70.7 years and 60% were male. Etiology was ischemic in 32% and mean left ventricular ejection fraction was 42%. After adjustment for covariates, discharge use of loop diuretics was associated with significant adverse risks of cardiac death (adjusted hazard ratio [HR] 2.348, 95% confidence interval [CI] 1.246-4.423, P=0.008) and rehospitalization (adjusted HR 1.427, 95% CI 1.040-1.959, P=0.027). Among patients hospitalized with worsening HF, loop diuretic use at discharge was associated with long-term adverse outcomes, which suggests that routine chronic use of loop diuretics may be harmful for patients with HF.

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.

Predictors of Long-Term Adverse Outcomes in Elderly Patients Over 80 Years Hospitalized With Heart Failure - A Report From the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) -

Aging is associated with adverse outcomes in patients with cardiac diseases. Whether elderly patients hospitalized with heart failure (HF) had increased risks for mortality and rehospitalization compared with younger patients during the long-term follow-up was examined. The predictors of these adverse outcomes were also identified. The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) studied prospectively the characteristics and treatments in a broad sample of 2,675 patients hospitalized with worsening HF and the outcomes were followed up. The majority of elderly patients were female, had lower body mass index (BMI), a higher rate of ischemic, valvular, and hypertensive heart disease as etiologies of HF, a lower estimated glomerular filtration rate (eGFR), lower hemoglobin, and higher left ventricular ejection fraction values. Even after adjustment for covariates, the elderly patients were associated with higher risks of adverse outcomes. The predictors for all-cause death were: lower eGFR, lower BMI, male sex, sustained ventricular tachycardia or fibrillation (VT/VF), and the use of diuretics at discharge. Among patients hospitalized with HF, elderly patients had a worse prognosis than younger patients. Lower eGFR, lower BMI, male sex, sustained VT/VF, and diuretic use were independent predictors for all-cause death in these patients with higher risk.

Hyperuricemia predicts adverse outcomes in patients with heart failure

BackgroundHyperuricemia is associated with worse outcomes of patients with chronic heart failure (HF). However, it is unknown in an unselected HF patients encountered in routine clinical practice. We thus assessed the impact of hyperuricemia on long-term outcomes including mortality and rehospitalization among patients hospitalized with worsening HF. MethodsThe Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) studied prospectively the characteristics and treatments in a broad sample of hospitalized HF patients and the outcomes were followed for 2.1years after discharge. Study cohorts (n=1869) were divided into 2 groups according to serum uric acid (UA) at discharge; ≥7.4mg/dL (n=908) and <7.4mg/dL (n=961). ResultsOf the total cohort of HF patients, 56% had hyperuricemia defined as UA≥7.0mg/dl. Patients with UA≥7.4mg/dL had higher rates of all-cause death, cardiac death, rehospitalization, and all-cause death or rehospitalization due to worsening HF. After multivariable adjustment, higher UA levels were a significant and independent predictor for all-cause death (adjusted hazard ratio [HR] 1.413, 95% confidence interval [CI] 1.094–1.824, P=0.008) and cardiac death (adjusted HR 1.399, 95% CI 1.020–1.920, P=0.037). ConclusionsHyperuricemia was common in patients with HF encountered in clinical practice and higher UA was independently associated with long-term adverse outcomes in these patients.

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.

Beta-Blocker Use at Discharge in Patients Hospitalized for Heart Failure Is Associated With Improved Survival

Previous studies demonstrated that beta-blocker use at the time of hospital discharge significantly increased postdischarge treatment rates, associated with an early (60- to 90-day) survival benefit in patients with heart failure (HF). However, it is unknown whether this therapeutic approach can also improve the long-term survival. We thus examined the long-term effects of beta-blocker use at discharge on outcomes in patients hospitalized for HF and left ventricular systolic dysfunction (LVSD) (ejection fraction <40%). The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) enrolled HF patients hospitalized with worsening symptoms and they were followed during an average of 2.2 years. A total of 947 patients had LVSD, among whom 624 (66%) were eligible to receive a beta-blocker at discharge. After adjustment for covariate and propensity score, discharge use of beta-blocker, when compared to no beta-blocker use, was associated with a significant reduced risk of all-cause mortality (hazard ratio (HR) 0.564, 95% confidence interval (CI) 0.358-0.889, P=0.014) and cardiac mortality (HR 0.489, 95%CI 0.279-0.859, P=0.013) after hospital discharge. Beta-blocker use at the time of discharge was associated with a long-term survival benefit in a diverse cohort of patients hospitalized with HF.

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.

Chronic Kidney Disease as an Independent Risk for Long-Term Adverse Outcomes in Patients Hospitalized With Heart Failure in Japan Report From the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)

Previous studies have demonstrated that renal dysfunction is common in patients with heart failure (HF), but it is not known whether chronic kidney disease (CKD) is associated with increased risks of long-term adverse outcomes in unselected HF patients encountered in current routine clinical practice in Japan. The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) prospectively studied a broad sample of patients hospitalized with worsening HF and their outcomes with an average of 2.4 years of follow-up. The study cohort (n=2,013) were classified into 3 groups by estimated glomerular filtration rate (eGFR): > or =60 (n=579), 30-59 (n=1,025), and <30 ml x min(-1) x 1.73 m(-2) or patients with dialysis (n=409); 1,372 patients (70.3%) had an eGFR <60 ml x min(-1) x 1.73 m(-2) and 62 patients were treated with dialysis. The multivariable adjusted risk for all-cause death or rehospitalization increased with reduced eGFR; an adjusted hazard ratio (HR) 1.520 (95% confidence interval (CI) 1.186-1.949) for eGFR 30-59 ml x min(-1) x 1.73 m(-2) (P=0.001) and HR 2.566 (95%CI 1.885-3.492) for eGFR <30 ml x min(-1) x 1.73 m(-2) or patients with dialysis (P<0.001). CKD is common in HF and was independently associated with long-term adverse outcomes in a broad cohort of Japanese patients.

Characteristics and Outcomes of Hospitalized Patients With Heart Failure and Reduced vs Preserved Ejection Fraction A Report From the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)

Heart failure (HF) with preserved ejection fraction (EF) is common. We compared the characteristics, treatments, and outcomes in HF patients with reduced vs preserved EF by using the national registry database in Japan. The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) is a prospective observational study in a broad sample of patients hospitalized with worsening HF. The study enrolled 2,675 patients from 164 hospitals with an average of 2.4 years of follow-up. Patients with preserved EF (EF >or=50% by echocardiography; n=429) were more likely to be older, female, have hypertension and atrial fibrillation, and less likely to have ischemic etiology compared with those with reduced EF (EF <40%; n=985). Unadjusted risk of in-hospital mortality (6.5% vs 3.9%; P=0.03) and post-discharge mortality (22.7% vs 17.8%; P=0.058) was slightly higher in patients with preserved EF, which, however, were not different after multivariable adjustment. Patients with preserved EF had similar rehospitalization rates (36.2% vs 33.4%; P=0.515) compared with patients with reduced EF. HF patients with preserved EF had a similar mortality risk and equally high rates of rehospitalization as those with reduced EF. Effective management strategies are critically needed to be established for this type of HF.

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.