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Muramatsu K, Aoyama Y, Shigemi D, Yasunaga H, Fushimi K, Matsuda S. Association between hospital case volume and maternal adverse events in patients with placental abruption: An analysis using a Japanese national inpatient database. Int J Gynaecol Obstet 2024. [PMID: 38760921 DOI: 10.1002/ijgo.15605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To clarify the relationship between the prognosis of patients with placental abruption (PA) and the healthcare delivery system using data from a large national inpatient database in Japan. METHODS Using the Diagnosis Procedure Combination database, we conducted a retrospective cohort study with the data of patients in almost 1000 hospitals with the primary diagnosis of PA who were hospitalized from April 2014 to March 2021. We divided the hospitals into four groups based on the number of deliveries per month. We performed multilevel logistic regression analysis to analyze the relationship between hospital case volume and maternal end-organ injury (MEOI). RESULTS Altogether, 8222 patients were included for analysis; among whom, 3575 (44%) were transferred by ambulance. MEOI was noted in 977 patients (12%) with no obvious difference by hospital case volume. Ambulance transfer, age, gestational weeks at admission, delivery on the first day of hospitalization, and history of eclampsia were significantly associated with a higher incidence of MEOI, but the hospital case volume was not. CONCLUSION Using a Japanese administrative database, our study shows that hospital case volume was not significantly associated with the severity of maternal illness among patients with PA.
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Affiliation(s)
- Keiji Muramatsu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Yoko Aoyama
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Daisuke Shigemi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
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Kitaoka H, Konishi T, Shitara Y, Ito A, Kashima K, Hashimoto Y, Matsui H, Kato M, Takahashi N, Yasunaga H. Treatments and outcomes of neonatal disseminated intravascular coagulation with and without neonatal asphyxia: A retrospective study using nationwide data in Japan. Pediatr Neonatol 2024; 65:117-122. [PMID: 37659900 DOI: 10.1016/j.pedneo.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/09/2023] [Accepted: 07/14/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Although neonatal disseminated intravascular coagulation (DIC) is associated with high mortality and severe complications, few studies have reported its clinical course. We aimed to describe the characteristics, treatments, and outcomes of neonatal DIC by using a national inpatient database. METHODS Using the Japanese Diagnosis Procedure Combination database, we identified 5533 patients with neonatal DIC who were admitted to neonatal intensive care units between July 2010 and March 2020. We categorized the patients into those with asphyxia (n = 2911) and those without asphyxia (n = 2622). We investigated the patient characteristics, treatments, and outcomes. We further categorized neonates with asphyxia according to its severity. RESULTS The gestational age of neonates with asphyxia was significantly lower than that of neonates without asphyxia (P < 0.001). Antithrombin was most commonly used for DIC (40%). Neonates with asphyxia were more likely to receive antithrombin (43% vs. 38%; P < 0.001), recombinant human soluble thrombomodulin (28% vs. 20%; P < 0.001), and fresh frozen plasma transfusion (68% vs. 51%; P < 0.001) than those without asphyxia. Neonates with asphyxia had higher in-hospital mortality (17% vs. 10%; P < 0.001), severe bleeding (11% vs. 6.8%; P < 0.001), and hospitalization costs than those without asphyxia. Additionally, neonates with severe asphyxia were more likely to receive several DIC therapies (such as recombinant human soluble thrombomodulin [30% vs. 24%]) and had higher in-hospital mortality (19% vs. 11%) and hospitalization costs than those with mild asphyxia. CONCLUSIONS In this large retrospective study of neonatal DIC, patients with asphyxia received several treatments and demonstrated unfavorable outcomes when compared to those without asphyxia.
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Affiliation(s)
- Hiroki Kitaoka
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan.
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Yoshihiko Shitara
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsushi Ito
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Kohei Kashima
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
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Ishibashi T, Kaneko H, Ueno K, Morita K, Itoh H, Okada A, Kamiya K, Suzuki Y, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Ako J, Node K, Yasunaga H, Komuro I. Association Between Early Initiation of Cardiac Rehabilitation and Short-Term Outcomes of Patients With Acute Heart Failure Admitted to the Intensive Care Unit. Am J Cardiol 2023; 206:285-291. [PMID: 37717477 DOI: 10.1016/j.amjcard.2023.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 09/19/2023]
Abstract
Cardiac rehabilitation (CR) is a promising therapeutic option for chronic heart failure (HF). However, the extent to which early rehabilitation is beneficial for patients receiving critical care remains controversial. This study examined the association between the early initiation of CR and the short-term clinical outcomes of patients admitted to the intensive care unit (ICU) with acute HF. We used the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan, and included patients with acute HF admitted to the ICU within 2 days after hospital admission. We defined the early initiation of CR as its initiation within 2 days of hospital admission. We performed an overlap weighting based on the propensity scores and inverse probability of treatment weighting analysis to compare the clinical outcomes between patients with and without early initiation of CR. Among 25,362 eligible patients, 3,582 (14.1%) received an early initiation of CR. Overlap weighting created well-balanced cohorts, which showed that the early initiation of CR was related to lower in-hospital mortality (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.68 to 0.96) and shorter hospital stay. The inverse probability of treatment weighting analysis also showed that in-hospital mortality was lower in the patients with the early initiation of CR (OR 0.80, 95% CI 0.67 to 0.96). The instrumental variable analysis also demonstrated the association of the early initiation of CR with lower in-hospital mortality (OR 0.64, 95% CI 0.44 to 0.93). In conclusion, early initiation of CR after hospital admission was associated with better short-term outcomes in patients with acute HF admitted to the ICU, suggesting the potential of the early administration of CR for acute HF requiring intensive care.
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Affiliation(s)
- Takuma Ishibashi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Kensuke Ueno
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Yuta Suzuki
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Matsuoka
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; International University of Health and Welfare, Tokyo, Japan
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Kitaoka H, Konishi T, Shitara Y, Ito A, Kashima K, Fujita A, Matsui H, Kato M, Takahashi N, Yasunaga H. Effects of Milrinone on Neonates after Patent Ductus Arteriosus Ligation: A Retrospective Nationwide Database Study. Neonatology 2023; 120:751-759. [PMID: 37757762 DOI: 10.1159/000533958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Milrinone is administered after patent ductus arteriosus (PDA) ligation to prevent and treat postoperative hemodynamic instability (i.e., postligation cardiac syndrome). We aimed to explore the effectiveness of milrinone on in-hospital outcomes in infants who underwent PDA ligation using a nationwide inpatient database in Japan. METHODS Using the Japanese Diagnosis Procedure Combination database, we identified patients who received milrinone after PDA ligation (n = 428) in neonatal intensive care units between July 2010 and March 2021 and those who did not (n = 3,392). We conducted a 1:4 propensity score-matched analysis with adjustment for background characteristics (e.g., gestational age, birth weight, comorbidities, preoperative treatments, and hospital background) to compare morbidities (bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity), mortality, total hospitalization costs, and other outcomes. For sensitivity analysis, we performed an overlap propensity score-weighted analysis. RESULTS In-hospital morbidity, bronchopulmonary dysplasia, intraventricular hemorrhage, and necrotizing enterocolitis occurred in 58%, 48%, 9.5%, and 7.1% of patients, respectively; the in-hospital mortality was 5.4%. After 1:4 propensity score matching, no significant difference was observed regarding mortality (7.1 vs. 5.7%), in-hospital morbidity (55 vs. 50%), bronchopulmonary dysplasia (44 vs. 41%), intraventricular hemorrhage (7.8 vs. 9.1%), necrotizing enterocolitis (8.5 vs. 8.9%), retinopathy of prematurity (21 vs. 22%), or total hospitalization costs (median: approximately 86,000 vs. 82,000 US dollars) between milrinone users (n = 425) and nonusers (n = 1,698). Sensitivity analyses yielded consistent results. CONCLUSIONS Milrinone use after PDA ligation was not associated with improved in-hospital outcomes, such as mortality and morbidity.
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Affiliation(s)
- Hiroki Kitaoka
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yoshihiko Shitara
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsushi Ito
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Kohei Kashima
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Asahi Fujita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Ueno K, Kaneko H, Kamiya K, Okada A, Itoh H, Konishi M, Sugimoto T, Suzuki Y, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Ako J, Node K, Yasunaga H, Komuro I. Association of early acute-phase rehabilitation initiation on outcomes among patients aged ≥90 years with acute heart failure. J Am Geriatr Soc 2023; 71:1840-1850. [PMID: 36856063 DOI: 10.1111/jgs.18283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Data on the potential benefit of acute-phase rehabilitation initiation in very old (aged ≥90) patients with acute heart failure (AHF) have been scarce. METHODS We retrospectively analyzed data from the Diagnosis Procedure Combination database, which is a nationwide inpatient database. This study included patients hospitalized for heart failure (HF) from January 2010 to March 2018, those aged ≥90 years, who had a length of stay of ≥3 days, New York Heart Association (NYHA) class of ≥II, and had not undergone major procedures under general anesthesia. Propensity score matching and generalized linear models were used to compare in-hospital mortality, length of stay, 30-day readmission rate due to HF, all-cause 30-day readmission, and improvement in activities of daily living (ADL) between patients with and without an acute-phase rehabilitation initiation, which is defined as the rehabilitation initiation within 2 days after hospital admission. RESULTS Acute-phase rehabilitation was initiated in 8588 of 41,896 eligible patients. Propensity score matching created 8587 pairs. Patients with acute-phase rehabilitation initiation have lower in-hospital mortality (9.0% vs. 11.2%, p < 0.001). Acute-phase rehabilitation initiation was associated with lower in-hospital mortality (odds ratio, 0.778; 95% confidence interval, 0.704-0.860). Patients with acute-phase rehabilitation initiation have a shorter median length of stay (17 days vs. 18 days, p < 0.001), lower 30-day readmission rate due to HF (5.5% vs. 6.4%, p = 0.011) and all-cause 30-day readmission (10.2% vs. 11.2%, p = 0.036), and better ADL improvement (49.7% vs. 46.9%, p < 0.001). Subgroup analysis revealed consistent results (sex, body mass index, NYHA class, and Barthel Index). CONCLUSIONS The acute-phase rehabilitation initiation was associated with improved short-term clinical outcomes in patients aged ≥90 years with AHF.
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Affiliation(s)
- Kensuke Ueno
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaaki Konishi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Tadafumi Sugimoto
- Department of Clinical Laboratory, Mie University Hospital, Mie, Japan
| | - Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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Weili L, Khan H, Khan I, Han L. The impact of information and communication technology, financial development, and energy consumption on carbon dioxide emission: evidence from the Belt and Road countries. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:27703-27718. [PMID: 34984617 DOI: 10.1007/s11356-021-18448-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
In today's digital era of globalization, information and communication technology (ICT) has been considered important that contributes to various sectors of an economy and increases economic growth; however, an increase in ICT may influence environmental quality which needs attention. For this purpose, this study examines the effect of ICT, energy consumption, economic growth, and financial development on carbon emission in the Belt and Road countries from 2000 to 2019 using OLS, fixed effect, dynamic system generalized method of moments (GMM), and generalized least square (GLS) models. The results indicate that ICT, financial development, energy consumption, and economic growth increase carbon dioxide emission, while renewable energy use and international trade reduce it. Foreign direct investment exerts both positive and negative effects on carbon emission across different models with different proxies of financial development. In the individual indicators model, only FBS seems to reduce carbon emission, while other indicators are positively associated with CO2 emission. The findings have considerable policy suggestions for the Belt and Road countries in the improvement of ICT sector, innovations, and enhancing financial institutions which can enhance environmental quality.
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Affiliation(s)
- Liu Weili
- China Center for Special Economic Zone Research, Shenzhen University, Shenzhen, China
| | - Hayat Khan
- China Center for Special Economic Zone Research, Shenzhen University, Shenzhen, China.
| | - Itbar Khan
- Business School of Xiangtan University, Xiangtan, Hunan, China
| | - Lei Han
- Business School of Xiangtan University, Xiangtan, Hunan, China
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Ueno K, Kamiya K, Kaneko H, Okada A, Itoh H, Fujiu K, Takeda N, Morita H, Michihata N, Jo T, Yasunaga H, Komuro I. Acute-Phase Initiation of Cardiac Rehabilitation for Short-Term Improvement in Activities of Daily Living in Patients Hospitalized for Acute Heart Failure. J Cardiovasc Dev Dis 2022; 9:97. [PMID: 35448073 PMCID: PMC9025467 DOI: 10.3390/jcdd9040097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Whether acute-phase cardiac rehabilitation (CR) is beneficial for short-term improvement in activities of daily living (ADL) in patients hospitalized for acute heart failure (AHF) remains unclear. AIM To investigate the association of acute-phase initiation of CR with short-term improvement in ADL in patients hospitalized for AHF. METHODS We retrospectively analyze data from the Diagnosis Procedure Combination Database, a nationwide inpatient database. Patients hospitalized for HF between January 2010 and March 2018 are included. Propensity score matching and generalized linear models are built to examine the association between improvement in ADL and acute-phase CR initiation, defined as the initiation of CR within two days of admission. RESULTS Among 306,826 eligible patients, CR is initiated in 45,428 patients (14.8%) within two days of hospital admission. Propensity score matching creates 45,427 pairs. CR initiation within two days of hospital admission is associated with ADL improvement (risk ratio: 1.018; 95% confidence interval: 1.004-1.032), particularly in elderly patients, females, and individuals with low ADL at admission, body mass index of 18.5-24.9 kg/m2, and New York Heart Association class IV. CONCLUSIONS Our analyses highlight the possibility that acute-phase CR initiation may result in short-term improvement in ADL in patients hospitalized for AHF.
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Affiliation(s)
- Kensuke Ueno
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara 252-0373, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara 252-0373, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
- Department of Advanced Cardiology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan;
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
- Department of Advanced Cardiology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
| | - Nobuaki Michihata
- Department of Health Services Research, The University of Tokyo, Tokyo 113-0033, Japan; (N.M.); (T.J.)
| | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo, Tokyo 113-0033, Japan; (N.M.); (T.J.)
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
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Itoh H, Kaneko H, Yotsumoto H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Serial Changes in Clinical Presentations and Outcomes of 5,740 Patients Requiring Repeated Hospital Admissions (Four or More Times) due to Worsened Heart Failure. Int Heart J 2020; 61:1253-1257. [PMID: 33191362 DOI: 10.1536/ihj.20-441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Heart failure (HF) is a major cause of death and hospitalization worldwide. In particular, hospital readmission due to worsened HF occurs frequently after the onset of HF. However, the association of repeated hospital admission with clinical manifestations and outcomes is unclear. The aim of this study was to clarify the serial changes in presentation and clinical course of patients requiring repeated hospital admission due to worsened HF. Among 466,921 patients who were admitted and discharged between January 2010 and March 2018, with the main discharge diagnosis of HF, we studied 5,740 patients who were hospitalized 4 times or more, using the Diagnosis Procedure Combination database. We evaluated serial changes in continuous data using the Jonckheere trend test, and categorical data using the Cochran-Armitage trend test. The median age of the patients was 78 years, and 3,326 patients (58%) were male. Body mass index and Barthel Index decreased with increased numbers of admissions. Patients requiring respiratory support and hemodialysis increased, whereas patients undergoing intra-aortic balloon pumping decreased with increased numbers of admissions. The length of hospital stay was prolonged and the interval between hospitalizations was shortened with increased numbers of hospital admissions. The in-hospital mortality rate was 8.8% at the fourth admission. In conclusion, this is the first large-scale real-world study on the serial changes in characteristics and outcomes of HF patients requiring repeated hospitalization, suggesting that repeated hospitalization might adversely affect the general status of patients with HF and result in a vicious clinical cycle.
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Affiliation(s)
- Hidetaka Itoh
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.,Department of Advanced Cardiology, Graduate School of Medicine, The University of Tokyo
| | - Haruki Yotsumoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Kiriyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Tatsuya Kamon
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.,Department of Advanced Cardiology, Graduate School of Medicine, The University of Tokyo
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | | | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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9
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Itoh H, Kaneko H, Kiriyama H, Kamon T, Fujiu K, Morita K, Yotsumoto H, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Reverse J-shaped relationship between body mass index and in-hospital mortality of patients hospitalized for heart failure in Japan. Heart Vessels 2020; 36:383-392. [PMID: 32980921 DOI: 10.1007/s00380-020-01699-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/04/2020] [Indexed: 01/18/2023]
Abstract
Several lines of evidence demonstrated body mass index (BMI) to be inversely associated with outcomes of patients with HF, so-called obesity paradox. However, the relationship between BMI and outcomes of patients with HF in Japan has been poorly understood. This study sought to explore the relationship between BMI and in-hospital mortality of patients hospitalized for heart failure (HF) in Japan and whether BMI at hospital admission could be used for the risk stratification of hospitalized HF patients. We studied 407,722 patients hospitalized for HF between January 2010 and March 2018, using the Diagnosis Procedure Combination database, a national inpatient database in Japan. Patients were categorized into four groups: underweight (BMI < 18.5 kg/m2), 66,342 patients (16.3%); normal (18.5-24.9 kg/m2), 240,801 patients (59.1%); pre-obesity (25.0-29.9 kg/m2), 76,954 patients (18.9%); and obesity (≥ 30.0 kg/m2), 23,625 patients (5.8%). Pre-obese and obese patients were younger and more likely to be male. Advanced HF symptoms were more common among underweight patients. Multivariable logistic regression analysis fitted with generalized estimating equation showed that, compared with normal weight patients underweight patients had higher in-hospital mortality (odds ratio 1.50, 95% confidence interval 1.45-1.55), whereas pre-obese patients (odds ratio 0.80, 95% confidence interval 0.77-0.83) and obese patients (odds ratio 0.90, 95% confidence interval 0.84-0.97) had lower in-hospital mortality. Restricted cubic spline showed a reverse J-shaped relationship between BMI and in-hospital mortality with the bottoms of splines around BMI 26 kg/m2. In conclusion, underweight patients had higher, and pre-obese and obese patients had lower in-hospital mortality compared to patients with normal weight patients. Furthermore, restricted cubic spline indicated a reverse J-shaped relationship between BMI and in-hospital mortality. Our findings are informative for the risk stratification of patients hospitalized for HF according to BMI.
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Affiliation(s)
- Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tatsuya Kamon
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Haruki Yotsumoto
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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10
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Kaneko H, Itoh H, Yotsumoto H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Association of Cancer With Outcomes in Patients Hospitalized for Heart Failure. Circ J 2020; 84:1771-1778. [PMID: 32921679 DOI: 10.1253/circj.cj-20-0314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The complex clinical status of heart failure (HF) patients with concomitant cancer is gaining clinical interest. This study sought to explore the prevalence of cancer in patients with HF and its effect on outcomes using a nationwide inpatient database.Methods and Results:In total, 447,818 HF patients who were admitted and discharged between January 2010 and March 2018 were studied and included in the Diagnosis Procedure Combination (DPC) database. The median age was 81 years; 238,192 patients (53.2%) were men and 25,951 (5.8%) had concomitant cancer. The prevalence of cancer peaked in patients aged in their 70 s and 80 s and increased with time. Patients with cancer were older and more likely to be male. Cigarette smoking was more common in patients with cancer. Patients with cancer more frequently had infectious complications during hospitalization. Advanced medical procedures were less frequently performed for patients with cancer. In-hospital mortality was higher in patients with cancer than those without (10.0% vs. 6.7%, P<0.001). Among patients with cancer, in-hospital mortality was higher in patients with metastasis than those without (18.9% vs. 9.4%, P<0.001). Multivariable logistic regression analysis, fitted with a generalized estimating equation, indicated cancer is associated with higher in-hospital mortality (odds ratio 1.51, 95% confidential interval 1.43-1.59, P<0.001). CONCLUSIONS Cancer was frequently observed in patients hospitalized for worsened HF, and its prevalence increased with time. The presence of cancer increased the risk of in-hospital death. Further studies are warranted to establish the optimal management strategy for HF patients with cancer in the field of cardio-oncology.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo.,Department of Advanced Cardiology, The University of Tokyo
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo
| | | | | | - Tatsuya Kamon
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo.,Department of Advanced Cardiology, The University of Tokyo
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | | | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo
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11
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Association between the number of hospital admissions and in-hospital outcomes in patients with heart failure. Hypertens Res 2020; 43:1385-1391. [PMID: 32655133 DOI: 10.1038/s41440-020-0505-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 11/08/2022]
Abstract
Readmission to the hospital is a major issue in clinical care for patients with heart failure (HF). However, the impact of the number of hospital admissions due to worsened HF is not fully understood. We sought to clarify the association between the number of hospital admissions due to worsened HF and patient outcomes. We studied 331,259 patients (median age was 81 years, and 175,286 patients (52.9%) were men) hospitalized for HF between January 2010 and March 2018 using the Japanese Diagnosis Procedure Combination Database, a national inpatient database. Patients were categorized into five groups based on the number of times they were admitted: once (n = 264,583), twice (n = 42,385), three times (n = 13,205), four times (n = 5347), and five or more times (n = 5739). The patients with larger numbers of admissions were more likely to have comorbidities and to use inotropic agents. The interval period between hospitalizations was shortened with an increasing number of hospital admissions, whereas the length of hospital stay was prolonged with an increasing number of hospital admissions. Multivariable logistic regression analysis fitted with a generalized estimating equation showed that an increased number of hospital admissions was independently associated with higher in-hospital mortality. In conclusion, readmission to the hospital due to worsened HF was still common, and in-hospital mortality was higher in those with larger numbers of readmissions, suggesting a clinical significance of the number of readmissions in patients with HF.
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12
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Kaneko H, Itoh H, Yotsumoto H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Morita H, Yasunaga H, Komuro I. Characteristics and Outcomes of Super-Elderly Patients (Aged ≥90 Years) Hospitalized for Heart Failure - Analysis of a Nationwide Inpatient Database. Circ Rep 2020; 2:393-399. [PMID: 33693260 PMCID: PMC7819647 DOI: 10.1253/circrep.cr-20-0053] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background:
Although the aged population is increasing in developed countries, clinical evidence on super-elderly heart failure (HF) patients is scarce. This study determined the characteristics and outcomes of Japanese hospitalized super-elderly HF patients (aged ≥90 years) using a nationwide inpatient database. Methods and Results:
A comprehensive analysis was performed of 447,818 HF patients in the Diagnosis Procedure Combination database who were hospitalized and discharged between January 2010 and March 2018. Among the study population, 243,028 patients (54.3%) were aged ≥80 years and 64,628 patients (14.4%) were aged ≥90 years. The percentage of elderly patients increased over time. Elderly patients were more likely to be female and had a higher New York Heart Association functional class at admission. Invasive and advanced procedures were rarely performed, whereas infectious complications were more common in patients with older age. Length of hospital stay and in-hospital mortality increased with age. Multivariable logistic regression analysis fitted with a generalized estimating equation showed higher in-hospital mortality in patients aged ≥80 and ≥90 years (odds ratios 1.99 and 3.23, respectively) compared with those aged <80 years. Conclusions:
The number of hospitalized super-elderly HF patients has increased, and these patients are associated with worse clinical outcomes. The results of this study may be useful in establishing an optimal management strategy for super-elderly HF patients in the era of HF pandemic.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan.,Department of Advanced Cardiology, The University of Tokyo Tokyo Japan
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Haruki Yotsumoto
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Hiroyuki Kiriyama
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Tatsuya Kamon
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan.,Department of Advanced Cardiology, The University of Tokyo Tokyo Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo Tokyo Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba Tsukuba Japan
| | - Nobuaki Michihata
- Department of Health Services Research, The University of Tokyo Tokyo Japan
| | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo Tokyo Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo Tokyo Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Tokyo Japan
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