Current Medical and Social Issues for Hospitalized Heart Failure Patients in Japan and Factors for Improving Their Outcomes　― Insights From the REAL-HF Registry ―

Abstract

Background: We investigated the current medical and social conditions and outcomes of heart failure (HF) patients in Hiroshima Prefecture, a local district in Japan. Methods and Results: From March 2017 to February 2018 we enrolled all adult patients with hospitalized HF in 8 regional core hospitals that provided an interprofessional team approach for HF patients. We collected patients’ clinical characteristics and information regarding living circumstances, cognitive function, quality of life, and interprofessional team approach. For patients discharged home, we followed up the primary endpoint (all-cause death and all-cause unscheduled readmission), conditions of outpatient cardiac rehabilitation, and home nursing-care services over a 1-year period after discharge. Of the registered patients (n=1,218), 39.2% were super-elderly (≥85 years old); more than half of these patients had preserved ejection fraction (≥50%). In the follow-up cohort (n=632), 140 patients (22.2%) were readmitted with HF exacerbation as the primary endpoint, and almost half (n=295, 46.7%) experienced any primary endpoint. The multivariate analysis adjusted for medical and social factors showed that completion of outpatient cardiac rehabilitation (5-month program) remained a strong negative predictor of the primary endpoint (hazard ratio: 0.15; 95% confidence interval: 0.05–0.48; P=0.0013). Conclusions: Our cohort study highlighted the super-aging of current HF patients in Japan. Cardiac rehabilitation through continuous team approach appears to be associated with favorable overall outcomes in this population.

Feasibility of home-based cardiac rehabilitation using an integrated telerehabilitation platform in elderly patients with heart failure: A pilot study

“…In a recent study using Medicare datasets in the USA, the proportion of participants who completed 36 CR sessions or more over 12 weeks was only 26.9% [22] . Further, a study using a nationwide registry in Japan reported that only 5.2% of patients completed a 5-month outpatient CR program [23] . In our present study, in contrast, all patients completed the 12-week program, and the participation rate was a notable 94.4%.…”

Development and appropriateness of a scoring method for International Classification of Functioning, Disabilities, and Health assessment in older patients with heart failure: a Delphi survey of expert panel in Japan

“…All 5 home physicians are specialists in internal medicine who engage in home visits while all 10 care managers are board members of the Hiroshima Care Manager Association and leaders in their respective communities. In addition, we included 11 medical multidisciplinary professionals involved in HF care at specialised medical institutions recommended by the Hiroshima Heart Health Promotion Project in our panel 37. The 11 medical multidisciplinary members were: 2 cardiovascular physicians, 2 nurses certified in chronic HF nursing, 2 physiotherapists with registered instructors of cardiac rehabilitation, 1 occupational therapist with registered instructors of cardiac rehabilitation, 1 certified pharmacist, 1 nutritionist and 1 social worker.…”

The International Classification of Functioning, Disabilities, and Health categories rated as necessary for care planning for older patients with heart failure: a survey of care managers in Japan

“…In addition, there is an increasing number of older people with HF facing various problems such as frailty, dementia, and living alone. A recent HF registry study in Japan showed that 39.2% of patients with HF were aged ≥85 years, and 21.7% lived alone [ 11 , 12 ]. Social support and information sharing may prevent rehospitalisation for HF [ 13 , 14 ], and establishing an information-sharing system between medical and welfare/care professionals in the community is an urgent issue.…”