University hospitals, general hospitals, private clinics: Place-based differences in patient characteristics and outcomes of AF—A SAKURA AF Registry Substudy

Abstract

A B S T R A C TBackground: Relations between characteristics and outcomes of patients in Japan with atrial fibrillation (AF) and the type of medical facility providing their outpatient care are unclear. Methods and results: We compared patient characteristics and outcomes between 2 university hospitals (n = 1178), 20 general hospitals (n = 1308), and 41 private clinics (n = 751) (follow-up: 39.3 months) in the prospective SAKURA AF Registry. Private clinic patients were significantly older than university hospital and general hospital patients (73.4 AE 9.2 vs. 70.3 AE 9.8 and 72.6 AE 8.9 years; p < 0.001), and these patients' CHADS 2 scores were significantly lower than general hospital, but higher than university hospital patients (1.8 AE 1.1 vs. 2.0 AE 1.2 and 1.6 AE 1.1; p < 0.001). The Kaplan-Meier incidences of stroke/ systemic embolism (SE) (1.72 vs. 1.58 vs. 0.84 events per 100 patient-years; p = 0.120), a cardiovascular event (4.09 vs. 2.44 vs. 1.40; p < 0.001), and death were higher (2.39 vs. 2.21 vs. 1.24; p = 0.015) for university and general hospital patients than for private clinic patients; the incidences of major bleeding were equivalent (1.78 vs. 1.33 vs. 1.16; p = 0.273). After multivariate adjustments, this trend persisted.

Clinical characteristics and outcomes of patients with chronic systemic inflammatory disease in acute myocardial infarction

“…The standardized definitions may be warranted to define CSIDs. Although diagnostic workups were done in the two study participating facilities as a university hospital and affiliated center [ 50 ], the diagnosis of CSIDs was based on medical records. Data are lacking on medical therapy before and after the hospitalization for acute MI, including immunomodulators and disease modifying anti-rheumatic drugs for CSIDs.…”

Association of patient satisfaction with direct oral anticoagulants and the clinical outcomes: Findings from the SAKURA AF registry

“…The patients were enrolled in the SAKURA AF Registry between September 1, 2013 and December 31, 2015 and have been followed up for at least 2 years since their enrollment (final follow-up ended in December 31, 2017). The study design, data collection, and baseline characteristics have been reported previously [11,14,15,17]. Patient eligibility for enrollment in the registry included the following: a diagnosis of nonvalvular AF based on a 12-lead electrocardiography (ECG) recording, 24-h Holter ECG recording, or event-activated ECG recording; an age !20 years; and treatment (either just initiated or already in place) with any anticoagulant drug for stroke prophylaxis.…”

“…To overcome those limitations of VKAs, direct oral anticoagulants (DOACs) have been developed, and randomized control trials [7][8][9][10] and several Japanese registries [11][12][13] have shown the benefit of these DOACs in reducing the risk of bleeding complications and/or stroke events in AF patients. DOACs are advantageous over VKAs/warfarin in terms of the clinical benefits and convenience [7][8][9][10][11][12][13][14][15][16][17] and thus, we found that Japanese patients given a DOAC were satisfied with their treatment for the burden assessed by a satisfaction questionnaire [anticoagulation-specific Anti-Clot Treatment Scale (ACTS)] [14]. Nonetheless, unexpectedly, the benefit satisfaction assessed by the ACTS appeared to be modestly lower than that in those given warfarin [14].…”

“…A website was created for the SAKURA AF Registry and is currently being used to collect all patient data through a webbased registration system [11,15,17]. The collected data comprise the patient clinical characteristics, including co-morbidities, medications, and laboratory test results, and the patient followup information.…”