1
|
Uemura Y, Shibata R, Ishikawa S, Takemoto K, Murohara T, Watarai M. The association between oral health status and physical function in elderly patients with acute heart failure. Clin Exp Dent Res 2024; 10:e824. [PMID: 38104262 PMCID: PMC10860531 DOI: 10.1002/cre2.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES Oral health problems are common and are associated with various geriatric conditions in older adults. The importance of oral health has not been fully highlighted in the assessment and management of patients with heart failure. Here, we investigated the association between oral health status and the decline in physical function during hospitalization in elderly patients with acute heart failure. MATERIALS AND METHODS We evaluated oral health using the revised oral assessment guide in 77 patients aged 65 years or older who were admitted to hospital for acute heart failure. Oral health problems were defined as a revised oral assessment guide score ≥9. RESULTS Oral health problems were identified in 66.2% of the patients. Patients with oral health problems had high prevalence of decreased physical function, undernutrition, and cognitive impairment. A reduction in the Barthel Index, as an indicator of activities of daily living during hospitalization, was significant in the enrolled patients. The Barthel Index decreased more in patients with oral health problems than those with normal oral health. Furthermore, the revised oral assessment guide score on admission was found to be the only independent predictor of changes in the Barthel Index during hospitalization in the multivariate analyses. CONCLUSIONS Oral assessment using the revised oral assessment guide during hospitalization could provide useful information for the management of elderly heart failure patients.
Collapse
Affiliation(s)
| | - Rei Shibata
- Department of Advanced Cardiovascular TherapeuticsNagoya University Graduate School of MedicineNagoyaJapan
| | | | | | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | | |
Collapse
|
2
|
Zhao X, Gan L, Niu Q, Hou FF, Liang X, Chen X, Chen Y, Zhao J, McCullough K, Ni Z, Zuo L. Clinical Outcomes in Patients on Hemodialysis with Congestive Heart Failure. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:306-316. [PMID: 37900002 PMCID: PMC10601911 DOI: 10.1159/000529802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/13/2023] [Indexed: 10/31/2023]
Abstract
Introduction Congestive heart failure (CHF) is one of the common complications in patients with end-stage kidney disease. In the general population, CHF increases the risk of the death. However, there is no well-designed relevant study in the Chinese hemodialysis (HD) population addressing the risks associated with CHF. The aim of this study was to explore the impact of CHF on clinical outcomes in HD patients. Methods Data from a prospective cohort study, the China Dialysis Outcomes and Practice Patterns Study (DOPPS) 5 (2012-2015), were analyzed. Demographic data, comorbidities, lab data, and death records were extracted. CHF was defined by the diagnosis records upon study inclusion. Our primary outcome was all-cause and cardiovascular (CV) mortality; secondary outcomes were all-cause and cause-specific hospitalization risk. Associations between CHF and outcomes were evaluated using Cox regression models. Stepwise multivariate logistic regression was used to identify the related risk factors, and subgroup analyses were carried out. Results Of 1,411 patients without missing CHF history information, 24.1% (340) had CHF diagnosis at enrollment. The overall mortality rates were 21.8% versus 12.0% (p < 0.001) in patients with and without CHF during follow-up, respectively. CHF was associated with higher all-cause mortality (adjusted HR: 1.72, 95% confidence interval [CI]: 1.17-2.53, p = 0.006), and the association with CV death was of similar magnitude (HR: 1.60, 95% CI: 0.91-2.81, p = 0.105). CHF patients had more episodes of hospitalization due to heart failure (HR: 2.93, 95% CI: 1.49-5.76, p < 0.01). However, compared with patients without CHF, the all-cause hospitalization risk was not much higher in CHF patients (HR: 1.09, 95% CI: 0.90-1.33, p = 0.39). Subgroup analysis found that the effect of CHF on all-cause mortality was stronger for male patients, patients with residual renal function, the elderly (≥60 years of age), patients with arteriovenous fistulae vascular accesses, nondiabetic patients, low-flux dialyzer users, and inadequately dialyzed patients (standardized Kt/V <2). Conclusion In HD patients, CHF was found to be associated with a higher risk of all-cause mortality and cause-specific hospitalization risk. Further research is needed to identify opportunities to improve care for HD patients combined with CHF.
Collapse
Affiliation(s)
- Xinju Zhao
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Liangying Gan
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Qingyu Niu
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Fan Fan Hou
- Division of Nephrology, National Clinical Research Center of Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xinling Liang
- Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaonong Chen
- Division of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuqing Chen
- Renal Division, Peking University First Hospital, Beijing, China
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Zuo
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| |
Collapse
|
3
|
Konishi M, Kaneko H, Itoh H, Matsuoka S, Okada A, Kamiya K, Sugimoto T, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Tamura K, Yasunaga H, Komuro I. Association of weight change and in-hospital mortality in patients with repeated hospitalization for heart failure. J Cachexia Sarcopenia Muscle 2023; 14:642-652. [PMID: 36564944 PMCID: PMC9891958 DOI: 10.1002/jcsm.13170] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/10/2022] [Accepted: 12/04/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although weight loss in heart failure (HF) is a detrimental condition known as cachexia, weight gain caused by fluid retention should also be considered harmful. However, studies with sufficient number of patients examining the impact of weight change and its interval on in-hospital mortality in HF have not been conducted thus far. We sought to elucidate the association of weight change with in-hospital mortality in patients with HF. METHODS This retrospective observational study used data from the Diagnosis Procedure Combination database, a nationwide inpatient health claims database in Japan. In total, 48 234 patients repeatedly hospitalized for HF (median 82 [74-87] years; 46.4% men) between 2010 and 2018 were included. Weight change was derived from body weight at the first and second admissions. RESULTS The median weight change and interval between two hospitalizations were -3.1 [-8.3 to -1.8] % and 172 [67-420] days, with 66.9% of overall cohort experiencing any weight loss. As a result of multivariable-adjusted logistic regression analysis, weight loss <-5.0% and weight gain >+5.0% were associated with increased in-hospital mortality (adjusted odds ratio [OR] [95% confidence interval]: 1.46 [1.31-1.62], P < 0.001 and 1.23 [1.08-1.40], P = 0.002, respectively) whereas mild weight loss and gain of 2.0-5.0% were not (OR [95% confidence interval]: 0.96 [0.84-1.10], P = 0.57 and 1.07 [0.92-1.25], P = 0.37, respectively), in comparison with patients with a stable weight (fluctuating no more than -2.0% to +2.0%) used as a reference. Restrictive cubic spline models adjusted for multiple background factors illustrated that higher mortality in patients with weight loss was observed across all subgroups of the baseline body mass index (<18.5, 18.5-24.9 and ≥25.0 kg/m2 ). In patients with short (<90 days) and middle (<180 days) intervals between the two hospitalizations, both weight loss and weight gain were associated with high mortality, whereas the association between weight gain and high mortality was attenuated in those with longer intervals. CONCLUSIONS Both weight loss and weight gain in patients with repeated hospitalization for HF were associated with high in-hospital mortality, especially weight loss and short/middle-term weight gain. Such patients should be treated with caution in a setting of repeated hospitalization for HF.
Collapse
Affiliation(s)
- Masaaki Konishi
- Department of Medical Science and Cardiorenal MedicineYokohama City University Graduate School of MedicineYokohamaJapan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine and Department of Advanced CardiologyThe University of TokyoTokyoJapan
| | - Hidetaka Itoh
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Satoshi Matsuoka
- Department of Cardiovascular MedicineNew Tokyo HospitalMatsudoJapan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health SciencesKitasato UniversitySagamiharaJapan
| | - Tadafumi Sugimoto
- Department of Cardiology and NephrologyMie University Graduate School of MedicineTsuJapan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine and Department of Advanced CardiologyThe University of TokyoTokyoJapan
| | - Nobuaki Michihata
- Department of Health Services ResearchThe University of TokyoTokyoJapan
| | - Taisuke Jo
- Department of Health Services ResearchThe University of TokyoTokyoJapan
| | - Norifumi Takeda
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Hiroyuki Morita
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal MedicineYokohama City University Graduate School of MedicineYokohamaJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
| | - Issei Komuro
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| |
Collapse
|
4
|
Miyazaki D, Tarasawa K, Fushimi K, Fujimori K. Risk Factors with 30-Day Readmission and the Impact of Length of Hospital Stay on It in Patients with Heart Failure: A Retrospective Observational Study Using a Japanese National Database. TOHOKU J EXP MED 2023; 259:151-162. [PMID: 36543246 DOI: 10.1620/tjem.2022.j114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Heart failure is a major disease, and its 30-day readmission (readmission within 30-day after discharge) negatively impacts patients and society. Thus, we need to stratify the risk and prevent readmission. We aimed to investigate risk factors associated with 30-day readmission and examine the impact of length of hospital stay (LOS) on 30-day readmission. Using the Diagnosis-Procedure-Combination database from April 2018 to March 2021, we conducted multiple logistic regression to investigate risk factors with 30-day readmission. Also, we conducted subgroup analysis in the short LOS group. To examine the association between LOS and 30-day readmission, we performed propensity score matching between the short and middle LOS groups. As a result, we categorized 10,283 patients and 169,842 patients into the readmission group and the no-readmission group. We identified the following factors as the risk of readmission: short LOS, female, smoking, older age, lower body mass index, lower barthel index, artificial ventilator, beta-blockers, thiazides, tolvaptan, loop diuretics, carperitides, class Ⅲ antiarrhythmic agents, myocardial infarction, diabetes, renal disease, atrial fibrillation, dilated cardiomyopathy, and discharge to home. As a subgroup analysis in the short LOS group, we revealed that the short LOS group risk factors differed from overall. After propensity score matching in the short LOS group and middle LOS group, 37,199 pairs were matched, and we revealed that shorter LOS increases the risk of readmission. These results demonstrated that shortened LOS increases 30-day readmission, and risk factors are unique to each LOS. We suggest stratifying the readmission risk and being careful with early discharge.
Collapse
Affiliation(s)
- Daisuke Miyazaki
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| |
Collapse
|
5
|
Kiriyama H, Kaneko H, Itoh H, Kamon T, Morita K, Jo T, Fujiu K, Daimon M, Takeda N, Morita H, Yasunaga H, Komuro I. Surgical treatment for infective endocarditis in the ageing society: a nationwide retrospective study in Japan. Open Heart 2021; 8:openhrt-2021-001627. [PMID: 33846222 PMCID: PMC8047992 DOI: 10.1136/openhrt-2021-001627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
Objective The current status of surgical treatment for infective endocarditis (IE) among very elderly people is unclear. Methods We extracted data on patients in Japan with community-acquired IE who were admitted and discharged between April 2010 and February 2018 using a nationwide inpatient, the Diagnosis Procedure Combination database. We divided patients into three groups: non-elderly (<65 years), elderly (65–79 years) and very elderly (≥80 years). A 1:1 propensity score matching was performed to compare proportions of surgical treatment and in-hospital mortality among the groups. Results We identified 20 667 eligible patients (median age 70 years, 61.0% men). The proportion of very elderly patients significantly increased (19.1% in 2010 to 29.7% in 2018). The proportion of surgical treatment was significantly lower, and in-hospital mortality was significantly higher in very elderly patients. This tendency was more pronounced among patients with in-hospital complications such as heart failure, stroke or embolism. Surgical treatment was significantly associated with lower in-hospital mortality even in very elderly patients, both in an unmatched (OR 0.61; 95% CI 0.47 to 0.78) and a propensity score matched cohort (OR 0.61; 95% CI 0.43 to 0.85). Conclusions The proportion of very elderly patients with IE was increasing, and very elderly patients had higher in-hospital mortality. The proportion of surgical treatment for IE among very elderly patients was low, but it was associated with lower in-hospital mortality. Further studies are needed to establish the optimal strategy for IE among very elderly patients.
Collapse
Affiliation(s)
- Hiroyuki Kiriyama
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of Advanced Cardiology, The University of Tokyo, Bunkyo-ku, Japan
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Tatsuya Kamon
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo, Bunkyo-ku, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of Advanced Cardiology, The University of Tokyo, Bunkyo-ku, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| |
Collapse
|