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Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, Miyamatsu N, Nishio Y, Ogura M, Sata M, Sekiguchi K, Takeya Y, Tamura K, Wakatsuki A, Yoshida H, Fujioka Y, Fukazawa R, Hamada O, Higashiyama A, Kabayama M, Kanaoka K, Kawaguchi K, Kosaka S, Kunimura A, Miyazaki A, Nii M, Sawano M, Terauchi M, Yagi S, Akasaka T, Minamino T, Miura K, Node K. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J 2024; 88:763-842. [PMID: 38479862 DOI: 10.1253/circj.cj-23-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuhiko Hara
- Department of Health and Nutrition, Wayo Women's University
| | - Hisashi Kai
- Department of Cardiology, Kurume Univeristy Medical Center
| | | | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Masatsune Ogura
- Department of General Medical Science, Chiba University School of Medicine
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Yasushi Takeya
- Division of Helath Science, Osaka University Gradiate School of Medicine
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | | | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Yoshio Fujioka
- Division of Clinical Nutrition, Faculty of Nutrition, Kobe Gakuin University
| | | | - Osamu Hamada
- Department of General Internal Medicine, Takatsuki General Hospital
| | | | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kenjiro Kawaguchi
- Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
| | | | | | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
- Yale New Haven Hospital Center for Outcomes Research and Evaluation
| | | | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Meidicine
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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Kawano H, Ikeda S, Kanaoka K, Sato S, Eto R, Ueno Y, Onoue K, Saito Y, Maemura K. Multisystemic Inflammation Influences Prognosis in Fulminant Lymphocytic Myocarditis. Circ J 2024; 88:722-731. [PMID: 38432947 DOI: 10.1253/circj.cj-23-0914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
BACKGROUND Multisystem inflammatory syndrome (MIS) is a hyperinflammatory shock associated with cardiac dysfunction and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, there are no reports on using MIS criteria, such as multisystemic inflammation (MSI) in fulminant myocarditis, without SARS-CoV-2 infection. This study investigated the differences in clinical characteristics and course between patients with fulminant lymphocytic myocarditis (FLM) plus MSI and those without MSI.Methods and Results: This multicenter retrospective cohort study included 273 patients with FLM registered in the JROAD-DPC database between April 2014 and March 2017. We evaluated the presence of MSI using criteria modified from previously reported MIS criteria and compared the characteristics and risk of mortality or heart transplantation between FLM patients with MSI and without MSI. Of the 273 patients with FLM, 107 (39%) were diagnosed with MSI. The MSI group was younger (44 vs. 57 years; P<0.0001) and had more females (50% vs. 36%; P=0.0236), a higher incidence of pericardial effusion (58% vs. 40%; P=0.0073), and a lower 90-day mortality rate (19% vs. 33%; P=0.0185) than the non-MSI group. The risk of mortality at 90 days was lower in FLM patients aged <50 years with MSI aged <50 years than in those without MSI (P=0.0463). CONCLUSIONS These results suggest that MSI may influence the prognosis of FLM, especially in patients aged <50 years.
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Affiliation(s)
- Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Nara Medical University
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital
| | - Ryo Eto
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Yuki Ueno
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
- Nara Prefecture Seiwa Medical Center
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
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3
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Tonegawa-Kuji R, Yamagata K, Kanaoka K, Wakamiya A, Inoue YY, Miyamoto K, Miyamoto Y, Kiyohara E, Kusano K. Maximum burn prevention practice vs conventional care after direct current cardioversion treatment: The BURN-PREVENTION trial. Heart Rhythm 2024:S1547-5271(24)02330-0. [PMID: 38599471 DOI: 10.1016/j.hrthm.2024.03.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Reina Tonegawa-Kuji
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan; Genomic Medicine Institute, Cleveland Clinic, Lerner Research Institute, Cleveland, Ohio
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akinori Wakamiya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuko Y Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Eiji Kiyohara
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
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4
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Kanaoka K, Onoue K, Terasaki S, Nakai M, Iwanaga Y, Miyamoto Y, Saito Y. Changes in Cardiac Function Following Fulminant Myocarditis. Circ Heart Fail 2024; 17:e010840. [PMID: 38572641 PMCID: PMC11008446 DOI: 10.1161/circheartfailure.123.010840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The natural history of myocardial dysfunction in patients with fulminant myocarditis is poorly understood. This study aims to evaluate changes in cardiac function in patients with fulminant myocarditis using a nationwide registry in Japan. METHODS This retrospective cohort study included patients with biopsy-proven fulminant myocarditis and available for left ventricular ejection fraction (LVEF). We described the LVEF on admission, at discharge, and 1 year after discharge. We divided patients into 2 groups based on LVEF at discharge (reduced ejection fraction of <50% or preserved ejection fraction of ≥50%) and analyzed changes in LVEF and prognosis according to groups. RESULTS We included 214 patients (the median [first-third quartiles] age of the cohort was 48 [35-62] years, and 63 [38%] were female). Of 153 patients available for LVEF at 1 year, the median (first-third quartiles) LVEF increased from 33% (21-45%) on admission to 59% (49-64%) at discharge and further to 61% (55-66%) at 1 year. Of 153 patients, 45 (29%) and 22 (14%) had LVEF <50% at discharge and at 1 year, respectively. Comparisons between patients with LVEF <50% and those with LVEF ≥50% demonstrated that the former group had a higher adjusted probability of death or heart transplantation (hazard ratio, 8.19 [95% CI, 2.13-31.5]; P=0.002). CONCLUSIONS Some patients with fulminant myocarditis had left ventricular dysfunction in the chronic phase. Patients with reduced left ventricular function at discharge had a worse prognosis than those with preserved left ventricular function. REGISTRATION URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045352; Unique identifier: UMIN000039763.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan (K.K., K.O., S.T., Y.S.)
- Department of Medical and Health Information Management (K.K., M.N., Y.I.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan (K.K., K.O., S.T., Y.S.)
| | - Satoshi Terasaki
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan (K.K., K.O., S.T., Y.S.)
| | - Michikazu Nakai
- Department of Medical and Health Information Management (K.K., M.N., Y.I.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Clinical Research Support Center, University of Miyazaki Hospital, Japan (M.N.)
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management (K.K., M.N., Y.I.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center (Y.M.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan (K.K., K.O., S.T., Y.S.)
- Nara Prefecture Seiwa Medical Center, Nara, Japan (Y.S.)
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Kanaoka K, Nishida T, Iwanaga Y, Nakai M, Tonegawa-Kuji R, Nishioka Y, Myojin T, Okada K, Noda T, Kusano K, Miyamoto Y, Saito Y, Imamura T. Oral anticoagulation after atrial fibrillation catheter ablation: benefits and risks. Eur Heart J 2024; 45:522-534. [PMID: 38117227 PMCID: PMC10873714 DOI: 10.1093/eurheartj/ehad798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND AND AIMS Few recent large-scale studies have evaluated the risks and benefits of continuing oral anticoagulant (OAC) therapy after catheter ablation (CA) for atrial fibrillation (AF). This study evaluated the status of continuation of OAC therapy and the association between continuation of OAC therapy and thromboembolic and bleeding events according to the CHADS2 score. METHODS This retrospective study included data from the Japanese nationwide administrative claims database of patients who underwent CA for AF between April 2014 and March 2021. Patients without AF recurrence assessed by administrative data of the treatment modalities were divided into two groups according to continuation of OAC therapy 6 months after the index CA. The primary outcomes were thromboembolism and major bleeding after a landmark period of 6 months. After inverse probability of treatment weighting analysis, the association between OAC continuation and outcomes was determined according to the CHADS2 score. RESULTS Among 231 374 patients included, 69.7%, 21.6%, and 8.7% had CHADS2 scores of ≤1, 2, and ≥3, respectively. Of these, 71% continued OAC therapy at 6 months. The OAC continuation rate was higher in the high CHADS2 score group than that in the low CHADS2 score group. Among all patients, 2451 patients (0.55 per 100 person-years) had thromboembolism and 2367 (0.53 per 100 person-years) had major bleeding. In the CHADS2 score ≤1 group, the hazard ratio of the continued OAC group was 0.86 [95% confidence interval (CI): 0.74-1.01, P = .06] for thromboembolism and was 1.51 (95% CI: 1.27-1.80, P < .001) for major bleeding. In the CHADS2 score ≥3 group, the hazard ratio of the continued OAC group was 0.61 (95% CI: 0.46-0.82, P = .001) for thromboembolism and was 1.05 (95% CI: 0.71-1.56, P = 0.81) for major bleeding. CONCLUSIONS This observational study suggests that the benefits and risks of continuing OAC therapy after CA for AF differ based on the patient's CHADS2 score. The risk of major bleeding due to OAC continuation seems to outweigh the risk reduction of thromboembolism in patients with lower thromboembolic risk.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
- Department of Cardiology, Sakurabashi-Watanabe Hospital, Umeda 2-4-32, Osaka, Osaka 530-0001, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
| | - Reina Tonegawa-Kuji
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Kishibe-Shimmachi 6-1, Suita, Osaka 564-8565, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
- Nara Prefecture Seiwa Medical Center, Sango, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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Ishisaka Y, Watanabe A, Aikawa T, Kanaoka K, Takagi H, Wiley J, Yasuhara J, Kuno T. Overview of SARS-CoV-2 infection and vaccine associated myocarditis compared to non-COVID-19-associated myocarditis: A systematic review and meta-analysis. Int J Cardiol 2024; 395:131401. [PMID: 37774926 DOI: 10.1016/j.ijcard.2023.131401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/05/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Previous literature suggests that both SARS-CoV-2 infection and COVID-19 mRNA vaccine are associated with myocarditis, in which the incidence is higher in the infection group. COVID-19 mRNA vaccine-related myocarditis is noted to have a more benign course. Despite these findings, there is a need for a larger population systematic review that compares the outcomes to pre-pandemic acute myocarditis to better understand the extent of the current post-COVID state. METHODS We performed a literature search with PubMed and EMBASE and identified studies investigating COVID-19 and its vaccinated population, and the population prior to the pandemic (control group) who had myocarditis. We performed a one-group meta-analysis of the incidence, baseline demographics, and outcomes of myocarditis for each group. RESULTS The incidence in the SARS-CoV-2 infection group was 2.76 per thousand (95% CI, 0.85-8.92), 19.7 per million (95% CI, 12.3-31.6) in the vaccine group, and 0.861 per million (95% CI, 0.04-16.7) in the control group. The majority of patients were male, with the highest proportion in the vaccine group. The mean age was the youngest in the vaccine group (24.8, 95% CI, 19.1-30.6). The vaccine group had the lowest mortality (2.0%, 95% CI, 1.3-2.7) followed by the control and the SARS-CoV-2 infection group. The vaccine group had the lowest proportion of immunoglobulin and glucocorticoid use, mechanical circulatory support, and cardiogenic shock. CONCLUSION Our study showed favorable outcomes of myocarditis in patients with COVID-19 mRNA vaccination, despite a higher incidence than pre-COVID controls. Further studies with standardized myocarditis diagnostic criteria assessing long-term outcomes are necessary.
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Affiliation(s)
- Yoshiko Ishisaka
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, New York, USA
| | - Atsuyuki Watanabe
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, New York, USA
| | - Tadao Aikawa
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Jose Wiley
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, LA, USA
| | - Jun Yasuhara
- Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, NY, New York, USA; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, NY, New York, USA.
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Ueda N, Noda T, Kanaoka K, Miyazaki Y, Wakamiya A, Nakajima K, Kamakura T, Wada M, Yamagata K, Ishibashi K, Inoue Y, Miyamoto K, Nagase S, Aiba T, Kanzaki H, Izumi C, Noguchi T, Yasuda S, Kusano K. Clinical Significance of Atrial Tachyarrhythmia Duration for Ventricular Arrhythmia in Patients With Cardiac Resynchronization Therapy. Circ J 2023:CJ-23-0547. [PMID: 38057103 DOI: 10.1253/circj.cj-23-0547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND Atrial tachyarrhythmias (ATAs) are reportedly associated with ventricular arrhythmias (VAs). However, little is known about the association between ATA duration and the risk of VA. We investigated the relationship between ATA duration and subsequent VA in patients with a cardiac resynchronization therapy defibrillator (CRT-D).Methods and Results: We investigated associations between the longest ATA duration during the first year after cardiac resynchronization therapy (CRT) implantation and VA and VA relevant to ATA (VAATA) in 160 CRT-D patients. ATAs occurred in 63 patients in the first year. During a median follow-up of 925 days from 1 year after CRT implantation, 40 patients experienced 483 VAs. Kaplan-Meier analysis showed a significantly higher risk of VA in patients with than without ATA in the first year (log rank P=0.0057). Hazard ratios (HR) of VA (HR 2.36, 2.10, and 3.04 for ATA >30s, >6 min and >24 h, respectively) and only VAATA (HR 4.50, 5.59, and 11.79 for ATA >30s, >6 min and >24 h, respectively) increased according to the duration of ATA. In multivariate analysis, ATA >24 h was an independent predictor of subsequent VA (HR 2.42; P=0.02). CONCLUSIONS Patients with ATA >24 h in the first year after CRT had a higher risk of subsequent VA and VAATA. The risk of VA, including VAATA, increased with the longest ATA duration.
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Affiliation(s)
- Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Koshiro Kanaoka
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | - Yuichiro Miyazaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Akinori Wakamiya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Kusano K, Yamane T, Inoue K, Takegami M, Nakai M, Kanaoka K, Tonegawa‐Kuji R, Miyamoto K, Iwasaki Y, Takatsuki S, Nakamura K, Iwanaga Y, Shimizu W. The Japanese Catheter Ablation Registry (J-AB): Annual report in 2021. J Arrhythm 2023; 39:853-859. [PMID: 38045445 PMCID: PMC10692843 DOI: 10.1002/joa3.12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/10/2023] [Indexed: 12/05/2023] Open
Abstract
The Japanese Catheter Ablation (J-AB) registry, started in August 2017, is a voluntary, nationwide, multicenter, prospective, observational registry, performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center using a Research Electronic Data Capture system. The purpose of this registry is to collect the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in the real-world settings. During the year of 2021, we have collected a total of 89 609 procedures (mean age of 66.1 years and 65.9% male) from 506 participant hospitals. Detailed data are shown in Figures and Tables.
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Affiliation(s)
- Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Teiichi Yamane
- Division of Cardiology Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Koichi Inoue
- Cardiovascular DivisionNational Hospital Organization Osaka National HospitalOsakaJapan
| | - Misa Takegami
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
- Department of Public Health and Health Policy, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Michikazu Nakai
- Department of Medical and Health Information ManagementNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Koshiro Kanaoka
- Department of Medical and Health Information ManagementNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Reina Tonegawa‐Kuji
- Department of Medical and Health Information ManagementNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Koji Miyamoto
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical SchoolBunkyo‐kuJapan
| | - Seiji Takatsuki
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Kohki Nakamura
- Division of CardiologyGunma Prefectural Cardiovascular CenterMaebashiJapan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information ManagementNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical SchoolBunkyo‐kuJapan
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9
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Matsumoto S, McMurray JJV, Nasu T, Ishii S, Kagiyama N, Kida K, Fujimoto W, Kikuchi A, Ijichi T, Shibata T, Ikeda T, Kanaoka K. Relevant adverse events and drug discontinuation of Sacubitril/valsartan in a real-world Japanese cohort: REVIEW-HF registry. J Cardiol 2023:S0914-5087(23)00276-9. [PMID: 38000538 DOI: 10.1016/j.jjcc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND The characteristics, tolerability, and outcomes in patients with heart failure (HF) who are treated with sacubitril/valsartan remain unclear in Japan. METHODS We conducted a nationwide multicenter study to evaluate the features and outcomes of patients newly prescribed sacubitril/valsartan for the management of HF. We analyzed adverse events (AEs) related to sacubitril/valsartan at 3 months, which were defined as hypotension, worsening renal function, hyperkalemia, and angioedema. Additionally, the association between AEs and outcomes was examined. RESULTS Among 993 patients, the mean age was 70 years and 291 (29.3 %) were female, and 22.8 % had left ventricular ejection fraction ≥50 %. Of them, 20.8 % had systolic blood pressure (sBP) <100 mmHg, and 19.5 % had estimated glomerular filtration rate (eGFR) <30 ml/min/1.73m2 at baseline, which were the populations excluded from the eligibility in landmark trials. AEs related to sacubitril/valsartan were observed in 22.5 % of the patients at 3 months. Overall, 22.6 % of patients discontinued sacubitril/valsartan, and hypotension was the most common event leading to drug discontinuation. After adjustment, patients who had worse HF symptoms (New York Heart Association III or IV), sBP <100 mmHg, and eGFR <30 ml/min/1.73m2 were associated with a higher risk of AEs related to sacubitril/valsartan. Additionally, patients experiencing AEs had a higher risk of cardiovascular death or HF hospitalization than those who did not. CONCLUSION In Japan, sacubitril/valsartan was also prescribed to patients not eligible for landmark trials, and AEs were observed at a relatively high rate from soon after treatment initiation. Physicians should closely monitor patients for these events, especially in patients anticipated to have a higher risk of AEs.
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Affiliation(s)
- Shingo Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Takahito Nasu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Health and Telemedicine, R&D, Tokyo, Japan
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Wataru Fujimoto
- Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, Hyogo, Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takeshi Ijichi
- Department of Cardiology, Tokai University School of Medicine, Osaka, Japan
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takanori Ikeda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
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10
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Abstract
BACKGROUND Heart failure (HF) is a global burden on healthcare systems, but the literature regarding nationwide trends in the care and outcomes of HF hospitalization in Japan is limited. Therefore, we aimed to investigate the trends in patient characteristics, treatment patterns, and outcomes of patients hospitalized with acute HF.Methods and Results: We used data from the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination database between April 2012 and March 2021 to analyze 840,357 patients aged ≥18 years who were hospitalized with an acute HF diagnosis. Over the study period (2012-2020), the mean (±standard deviation) age increased from 78.9 (±11.9) years to 80.9 (±11.8) years (P for trend <0.001), the proportion of female patients decreased from 48.7% to 47.5% (P for trend=0.02), crude in-hospital mortality rate decreased from 11.5% to 10.9%, and 30-day HF readmissions decreased from 7.4% to 7.0% (both P for trend <0.001). The reduction in outcomes was more apparent in the older age groups. The standardized outcomes demonstrated the same trends as the crude outcomes. CONCLUSIONS Our nationwide hospital admission analysis clarified that patients hospitalized with acute HF were getting older, but mortality and readmission rates also decreased, especially in older patients during the 2010s.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Department of Biostatistics, National Cerebral and Cardiovascular Center
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11
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Kurahara Y, Kanaoka K, Tanaka Y, Maeda Y, Kobayashi T, Takeuchi N, Kagawa T, Tachibana K, Yoshida S, Tsuyuguchi K. Management of dysphonia caused by amikacin liposome inhalation in M. avium complex pulmonary disease. Int J Tuberc Lung Dis 2023; 27:872-873. [PMID: 37880889 DOI: 10.5588/ijtld.23.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Affiliation(s)
- Y Kurahara
- Department of Internal Medicine, Department of Infectious Diseases, and, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka
| | - K Kanaoka
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka
| | - Y Tanaka
- Department of Internal Medicine, Department of Infectious Diseases, and
| | - Y Maeda
- Department of Otorhinolaryngology, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Osaka, Japan
| | - T Kobayashi
- Department of Otorhinolaryngology, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Osaka, Japan
| | | | | | - K Tachibana
- Department of Internal Medicine, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka
| | - S Yoshida
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka
| | - K Tsuyuguchi
- Department of Internal Medicine, Department of Infectious Diseases, and, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka
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12
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Wada S, Iwanaga Y, Sumita, Y, Sasahara Y, Kanaoka K, Takekawa H, Sumita S, Miyamoto Y. Satisfaction Survey for Regional Clinical Pathway for Stroke Patients in Acute and Rehabilitation Hospitals in Japan. Prog Rehabil Med 2023; 8:20230021. [PMID: 37456918 PMCID: PMC10338178 DOI: 10.2490/prm.20230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives We collected opinions about the use of a stroke-specific regional clinical pathway for facilitating collaboration between acute and rehabilitation hospitals in Japan. Methods The study surveys were administered in acute hospitals designated as primary stroke centers and certified by the Japan Stroke Association (n=961) and in rehabilitation hospitals affiliated with the Kaifukuki Rehabilitation Ward Association (n=1237). The survey collected information on interfacility collaboration when caring for patients admitted during the acute phase following non-traumatic stroke from April 2020 to March 2021. We examined the pathway's usefulness and challenges relative to facility type using the χ2 test. Results Of 422 acute hospitals and 223 rehabilitation hospitals that responded to our survey, 259 (62.1%) acute hospitals and 164 (85.4%) rehabilitation hospitals used the pathway. Fewer rehabilitation hospitals than acute hospitals considered that the pathway was useful (52.0% vs. 63.8%, P=0.02). Fewer rehabilitation hospitals did not experience pathway-related problems when compared with acute hospitals (38.0% vs. 55.8%, P<0.01). Conclusions Personnel at rehabilitation hospitals were less satisfied with the regional clinical care pathway than those in acute hospitals. These results suggest that the current stroke-specific regional clinical pathway could be improved.
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Affiliation(s)
- Shinichi Wada
- Department of Medical and Health Information Management,
National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management,
National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoko Sumita,
- Department of Medical and Health Information Management,
National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yusuke Sasahara
- Department of Medical and Health Information Management,
National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management,
National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management,
National Cerebral and Cardiovascular Center, Suita, Japan
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13
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Sodium-Glucose Cotransporter 2 Inhibitor Use in Early-Phase Acute Coronary Syndrome with Severe Heart Failure. Eur Heart J Cardiovasc Pharmacother 2023:7161119. [PMID: 37173281 DOI: 10.1093/ehjcvp/pvad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
AIMS Sodium-glucose cotransporter 2 inhibitor (SGLT2i) improves clinical outcomes in patients with heart failure (HF), but has limited evidence of SGLT2i use on early-phase acute coronary syndrome (ACS). We determined association of early SGLT2i use compared with either non-SGLT2i or dipeptidyl peptidase 4 inhibitor (DPP4i) in hospitalized patients with ACS. METHODS AND RESULTS This retrospective cohort study that used the Japanese nationwide administrative claims database included patients hospitalized with ACS aged ≥ 20 years between April 2014 and March 2021. The primary outcome was a composite of all-cause mortality or HF/ACS rehospitalization. Using 1:1 propensity score matching, the association with outcomes of the early SGLT2i use (≤14 days after admission) compared with non-SGLT2i or DPP4i was determined according to the HF treatment. Among 388 185 patients included, 115 612 and 272 573 with and without severe HF, respectively. Compared to non-SGLT2i users, the SGLT2i users had a lower hazard ratio (HR) with the primary outcome (HR: 0.83, 95% confidence interval [CI]: 0.76-0.91, p < 0.001) in the severe HF group; however, there was no significant difference in the non-severe HF group (HR: 0.92, 95% CI: 0.82-1.03, p = 0.16). SGLT2i use showed a lower risk of the outcome in patients with severe HF and diabetes compared with DPP4i (HR: 0.83, 95% CI: 0.69-1.00, p = 0.049). CONCLUSION SGLT2i use in patients with early-phase ACS showed a lower risk of primary outcome in patients with severe HF but the effect was not apparent in patients without severe HF.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Sakurabashi-Watanabe Hospital, Osaka, Osaka, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
- Nara Prefecture Seiwa Medical Center, Oji, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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14
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Kyodo A, Kanaoka K, Keshi A, Nogi M, Nogi K, Ishihara S, Kamon D, Hashimoto Y, Nakada Y, Ueda T, Seno A, Nishida T, Onoue K, Soeda T, Kawakami R, Watanabe M, Nagai T, Anzai T, Saito Y. Heart failure with preserved ejection fraction phenogroup classification using machine learning. ESC Heart Fail 2023; 10:2019-2030. [PMID: 37051638 DOI: 10.1002/ehf2.14368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 01/05/2023] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
AIMS Heart failure (HF) with preserved ejection fraction (HFpEF) is a complex syndrome with a poor prognosis. Phenotyping is required to identify subtype-dependent treatment strategies. Phenotypes of Japanese HFpEF patients are not fully elucidated, whose obesity is much less than Western patients. This study aimed to reveal model-based phenomapping using unsupervised machine learning (ML) for HFpEF in Japanese patients. METHODS AND RESULTS We studied 365 patients with HFpEF (left ventricular ejection fraction >50%) as a derivation cohort from the Nara Registry and Analyses for Heart Failure (NARA-HF), which registered patients with hospitalization by acute decompensated HF. We used unsupervised ML with a variational Bayesian-Gaussian mixture model (VBGMM) with common clinical variables. We also performed hierarchical clustering on the derivation cohort. We adopted 230 patients in the Japanese Heart Failure Syndrome with Preserved Ejection Fraction Registry as the validation cohort for VBGMM. The primary endpoint was defined as all-cause death and HF readmission within 5 years. Supervised ML was performed on the composite cohort of derivation and validation. The optimal number of clusters was three because of the probable distribution of VBGMM and the minimum Bayesian information criterion, and we stratified HFpEF into three phenogroups. Phenogroup 1 (n = 125) was older (mean age 78.9 ± 9.1 years) and predominantly male (57.6%), with the worst kidney function (mean estimated glomerular filtration rate 28.5 ± 9.7 mL/min/1.73 m2 ) and a high incidence of atherosclerotic factor. Phenogroup 2 (n = 200) had older individuals (mean age 78.8 ± 9.7 years), the lowest body mass index (BMI; 22.78 ± 3.94), and the highest incidence of women (57.5%) and atrial fibrillation (56.5%). Phenogroup 3 (n = 40) was the youngest (mean age 63.5 ± 11.2) and predominantly male (63.5 ± 11.2), with the highest BMI (27.46 ± 5.85) and a high incidence of left ventricular hypertrophy. We characterized these three phenogroups as atherosclerosis and chronic kidney disease, atrial fibrillation, and younger and left ventricular hypertrophy groups, respectively. At the primary endpoint, Phenogroup 1 demonstrated the worst prognosis (Phenogroups 1-3: 72.0% vs. 58.5% vs. 45%, P = 0.0036). We also successfully classified a derivation cohort into three similar phenogroups using VBGMM. Hierarchical and supervised clustering successfully showed the reproducibility of the three phenogroups. CONCLUSIONS ML could successfully stratify Japanese HFpEF patients into three phenogroups (atherosclerosis and chronic kidney disease, atrial fibrillation, and younger and left ventricular hypertrophy groups).
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Affiliation(s)
- Atsushi Kyodo
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Ayaka Keshi
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Maki Nogi
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Satomi Ishihara
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yasuki Nakada
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Ayako Seno
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tsuneari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
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15
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Okada K, Noda T, Miyamoto Y, Saito Y, Imamura T. Reduction in Planned Percutaneous Coronary Interventions After the Policy Change for Ischemia Assessment in Japan. JACC Asia 2023; 3:312-314. [PMID: 37181398 PMCID: PMC10167499 DOI: 10.1016/j.jacasi.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Shijo-cho 840, Kashihara, Nara 634-8521, Japan @koshiroook
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16
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Tonegawa-Kuji R, Kanaoka K, Iwanaga Y. Current status of real-world big data research in the cardiovascular field in Japan. J Cardiol 2023; 81:307-315. [PMID: 36126909 DOI: 10.1016/j.jjcc.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 02/01/2023]
Abstract
Real-world data (RWD) are observational data obtained by collecting, structuring, and accumulating patient information among the medical big data. RWD are derived from a variety of patient medical care and health information outside of conventional research data, and include electronic health records, claims data, registry data of disease, drug and device, health check-up data, and more recently, patient information data from wearable devices. They are currently being utilized in various forms for optimal medical care and real-world evidence (RWE) is constructed through a process of hypothesis generation and verification based on the RWD research. Together with classic clinical research and pragmatic trials, RWE shapes the learning healthcare system and contributes to the improvement of medical care. In the cardiovascular medical care of the current super-aged society, the need for a variety of RWE and the research is increasing, since the guidelines established over time and the medical care based on it cannot necessarily be the best in accordance with the current medical situation. In this review, we focus on the RWD and RWE studies in the cardiovascular medical field and outlines their current status in Japan. Furthermore, we discuss the potential for extending the studies and issues related to the use of medical big data and RWD.
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Affiliation(s)
- Reina Tonegawa-Kuji
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan.
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17
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Suematsu Y, Miura SI, Minei A, Sumita Y, Kanaoka K, Nakai M, Arima H, Nakamura K, Takura T, Shimada K, Shiraishi H, Fukuma N, Ohya Y, Makita S. Study Protocol of Cardiac Rehabilitation for Acute Myocardial Infarction From the JROAD/JROAD-DPC Database - JROAD-CR. Circ Rep 2023; 5:62-65. [PMID: 36818518 PMCID: PMC9908525 DOI: 10.1253/circrep.cr-22-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/22/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023] Open
Abstract
Background: Although cardiac rehabilitation (CR) has been reported to be effective for improving the prognosis of acute myocardial infarction (AMI), more patients must participate in CR during admission and as outpatients. Factors contributing to, and countermeasures against, the low CR participation rate need to be identified. Here we describe the protocol for a study designed to evaluate the effectiveness and problems of CR for AMI from the Japanese Registry of All Cardiac and Vascular Diseases (JROAD) and the JROAD-Japanese Diagnosis Procedure Combination system (JROAD-DPC) database. Methods and Results: This is a multicenter retrospective cohort study that will use the JROAD/JROAD-DPC database to evaluate the effectiveness of CR for AMI (JROAD-CR). Five thousand patients with AMI who were admitted to hospitals registered in the JROAD database in 2014 will be investigated with regard to their baseline characteristics, AMI severity and treatment, examination results, history of CR, and prognosis up to 5 years. We will also investigate the presence, quantity, and quality of CR, and evaluate the effectiveness of CR with respect to cost, exercise tolerance, and prognosis during admission and follow-up. Conclusions: The JROAD-CR study will seek to reveal the effectiveness of CR for AMI in the era of early reperfusion therapy and shortened hospitalization.
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Affiliation(s)
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of MedicineFukuokaJapan
| | - Akira Minei
- Department of Rehabilitation, University of the Ryukyu HospitalOkinawaJapan
| | - Yoko Sumita
- National Cerebral and Cardiovascular CenterOsakaJapan
| | | | | | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka UniversityFukuokaJapan
| | - Koshi Nakamura
- Department of Public Health and Hygiene, Graduate School of Medicine, University of the RyukyusOkinawaJapan
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of TokyoTokyoJapan
| | | | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of MedicineKyotoJapan
| | - Nagaharu Fukuma
- Faculty of Rehabilitation and Care, Seijoh UniversityAichiJapan
| | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the RyukyusOkinawaJapan
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama International Medical Center, Saitama Medical UniversitySaitamaJapan
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18
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Tonegawa-Kuji R, Nakai M, Kanaoka K, Sumita Y, Miyamoto Y, Kusano K, Iwanaga Y, Yamane T. Impact of Low Body Mass Index on Cardiac Tamponade During Catheter Ablation for Atrial Fibrillation. JACC Clin Electrophysiol 2023; 9:200-208. [PMID: 36858686 DOI: 10.1016/j.jacep.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/04/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cardiac tamponade is a potentially fatal complication of catheter ablation for atrial fibrillation (AF). OBJECTIVES This study aimed to evaluate the impact of body mass index (BMI) on cardiac tamponade during AF ablation. METHODS Patients who underwent catheter ablation for AF between April 1, 2016 and March 31, 2018 were analyzed using a Japanese nationwide claims database. Mixed-effects multivariable Poisson regression analysis was performed to investigate the association between BMI and cardiac tamponade. RESULTS A total of 59,789 hospitalizations (age 65.6 ± 10.4 years, 29% women) with catheter ablation for AF were analyzed. Cardiac tamponade occurred in 647 patients (1.1%). Multivariable analysis revealed that being underweight (BMI <18.5 kg/m2) was associated with an increased risk of cardiac tamponade (relative risk [RR]: 1.42; 95% CI: 1.03-1.95) when compared with having a normal weight (BMI ≥18.5 and <25 kg/m2). Other characteristics that were associated with an increased risk of cardiac tamponade were age ≥75 years, female sex, and a history of heart failure, hypertension, diabetes, and dialysis treatment. CONCLUSIONS In this analysis of a large nationwide database of patients with AF who underwent ablation, being underweight was independently associated with an increased risk of cardiac tamponade during AF ablation. Clinicians should consider the higher risk of cardiac tamponade in the underweight population and take appropriate measures to reduce this risk.
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Affiliation(s)
- Reina Tonegawa-Kuji
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teiichi Yamane
- Division of Cardiology, Jikei University School of Medicine, Tokyo, Japan
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19
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Kanaoka K, Iwanaga Y, Nakai M, Sumita Y, Saito Y, Miyamoto Y. Temporal Trends and Regional Variations in Cardiovascular Care in Japan, 2010-2019. Int Heart J 2023; 64:53-59. [PMID: 36725073 DOI: 10.1536/ihj.22-445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiovascular diseases are a major cause of mortality worldwide. Nonetheless, the current trend in cardiology hospitals in Japan has not been comprehensively explored.This descriptive study used the Japanese Registry of All Cardiac and Vascular Diseases database during 2010-2019. The nationwide 10-year trend in cardiovascular medical care systems was described in detail corresponding to the regions in Japan.Cardiovascular facilities and the number of cardiology beds, hospitalized patients, and cardiologists increased during 2010-2019. There were regional differences in the number of patients and cardiologists per bed, but the differences in the number of hospitalized patients per cardiologist decreased among the regions. Of the three major acute cardiovascular diseases, patients hospitalized with heart failure per cardiologist have been increasing. However, the in-hospital mortality rates have not changed over the last decade (8.6% for acute myocardial infarction, 7.7% for heart failure, and 12.7% for acute aortic dissection in 2019).There was an increasing trend in the availability of cardiovascular care resources in Japan during 2010-2019. This study provides a comprehensive summary of the current cardiovascular care and the follow-up required in the future.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center.,Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
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20
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Kanaoka K, Iwanaga Y, Okada K, Terasaki S, Nishioka Y, Nakai M, Kamon D, Myojin T, Soeda T, Noda T, Horii M, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Validity of Diagnostic Algorithms for Cardiovascular Diseases in Japanese Health Insurance Claims. Circ J 2023; 87:536-542. [PMID: 36709984 DOI: 10.1253/circj.cj-22-0566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND We aimed to validate a claims-based diagnostic algorithm to identify hospitalized patients with acute major cardiovascular diseases (CVDs) from health insurance claims in Japan.Methods and Results: This retrospective multicenter validation study was conducted at 4 institutes, including Japanese Circulation Society-certified and uncertified hospitals in Japan. Data on patients with CVDs in departmental lists or with International Classification of Diseases, 10th Revision (ICD-10) codes for CVDs hospitalized between April 2018 and March 2019 were extracted. We examined the sensitivity and positive predictive value of a diagnostic algorithm using ICD-10 codes, medical examinations, and treatments for acute coronary syndrome (ACS), acute heart failure (HF), and acute aortic disease (AAD). We identified 409 patients with ACS (mean age 70.6 years; 24.7% female), 615 patients with acute HF (mean age 77.3 years; 46.2% female), and 122 patients with AAD (mean age 73.4 years; 36.1% female). The respective sensitivity and positive predictive value for the algorithm were 0.86 (95% confidence interval [CI] 0.82-0.89) and 0.95 (95% CI 0.92-0.97) for ACS; 0.74 (95% CI 0.70-0.77) and 0.79 (95% CI 0.76-0.83) for acute HF; and 0.86 (95% CI 0.79-0.92) and 0.83 (95% CI 0.76-0.89) for AAD. CONCLUSIONS The validity of the diagnostic algorithm for Japanese claims data was acceptable. Our results serve as a foundation for future studies on CVDs using nationwide administrative data.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center.,Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine.,Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine
| | | | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Manabu Horii
- Department of Cardiovascular Medicine, Nara City Hospital
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University
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21
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Tonegawa-Kuji R, Inoue YY, Nakai M, Kanaoka K, Sumita Y, Miyazaki Y, Wakamiya A, Shimamoto K, Ueda N, Nakajima K, Wada M, Kamakura T, Yamagata K, Ishibashi K, Miyamoto K, Nagase S, Aiba T, Miyamoto Y, Iwanaga Y, Kusano K. Differences in patient characteristics, clinical practice and outcomes of cardiac implantable electric device therapy between Japan and the USA: a cross-sectional study using data from nationally representative administrative databases. BMJ Open 2023; 13:e068124. [PMID: 36639209 PMCID: PMC9843182 DOI: 10.1136/bmjopen-2022-068124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To identify differences in patient characteristics, clinical practice and outcomes of cardiac implantable electronic device (CIED) therapy between Japan and the USA. DESIGN A cross-sectional study. SETTING Nationally representative administrative databases from Japan and the USA containing hospitalisations with first-time implantations of pacemakers, implantable cardioverter-defibrillators (ICD) and cardiac-resynchronisation therapy with or without defibrillators (CRTP/CRTD). PARTICIPANTS Patients hospitalised with first-time implantations of CIEDs. OUTCOME MEASURES In-hospital mortality, in-hospital complication and 30-day readmission rates. RESULTS Overall, 107 339 (median age 78 (71-84), 48 415 women) and 295 584 (age 76 (67-83), 127 349 women) records with CIED implantations were included from Japan and the USA, respectively. Proportion of women in defibrillator recipients was lower in Japan than in the USA (ICD, 21% vs 28%, p<0.001; CRTD, 24% vs 29%, p<0.001). Length of stay after CIED implantation was longer in Japan than in the USA for all device types (conventional pacemaker, 8(7-11) vs 1 (1-3) days, p<0.001; leadless pacemaker, 5 (3-9) vs 2 (1-5) days, p<0.001; ICD, 8 (7-11) vs 1 (1-3) days, p<0.001, CRTP, 9 (7-13) vs 2 (1-4) days, p<0.001; CRTD, 9 (8-14) vs 2 (1-4) days, p<0.001). In-hospital mortality after CIED implantation was similar between Japan and the USA ((OR) (95% CI), conventional pacemaker 0.58 (0.83 to 1.004); ICD 0.77 (0.57 to 1.03); CRTP 0.85 (0.51 to 1.44); CRTD 1.11 (0.81 to 1.51)), except that after leadless pacemaker implantation in Japan was lower than that in the USA (0.32 (0.23 to 0.43)). 30-day readmission rates were lower in Japan than in the USA for all device types (conventional pacemaker 0.55 (0.53 to 0.57); leadless pacemaker 0.50 (0.43 to 0.58); ICD 0.54 (0.49 to 0.58); CRTP 0.51 (0.42 to 0.62); CRTD 0.57 (0.51 to 0.64)). CONCLUSIONS International variations in patient characteristics, practice and outcomes were observed. In-hospital mortality after CIED implantation was similar between Japan and the USA, except in cases of leadless pacemaker recipients.
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Affiliation(s)
- Reina Tonegawa-Kuji
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuko Y Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuichiro Miyazaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akinori Wakamiya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Keiko Shimamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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22
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Soeda T, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Outpatient cardiac rehabilitation dose after acute coronary syndrome in a nationwide cohort. Heart 2022; 109:40-46. [PMID: 35241624 DOI: 10.1136/heartjnl-2021-320434] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Cardiac rehabilitation (CR) is effective in patients with acute coronary syndrome (ACS); however, CR programmes have not been fully implemented. This study aimed to reveal the current practice of outpatient CR and the dose-effect relationship of CR in real-world settings. METHODS We performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with ACS who underwent percutaneous coronary intervention between April 2014 and March 2018 were included. We analysed the implementation rate and dose of outpatient CR and the association between dose and outcomes. RESULTS Out of 202 320 patients who underwent percutaneous coronary intervention for ACS, a total of 20 444 (10%) underwent outpatient CR. The median (IQR) number of total CR sessions was 9 (3-17), and the median (IQR) duration for each session was 60 (42-60) min. Patients were divided into four groups according to the total number of sessions (≤9 times or ≥10 times) and the duration per session (<50 min or ≥50 min). Compared with the low-number/short-duration group, the adjusted HR for all-cause mortality was 1.00 (95% CI 0.80 to 1.24, p=0.97) in the low-number/long-duration group, 0.63 (95% CI 0.46 to 0.87, p=0.005) in the high-number/short-duration group and 0.74 (95% CI 0.60 to 0.92, p=0.008) in the high-number/long-duration group, respectively. CONCLUSION We found that the participation rate for outpatient CR after ACS was low and the doses of sessions vary in real-world settings. A higher number of total sessions of outpatient CR is associated with a better prognosis irrespective of the session's duration.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuichi Nishioka
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Tomoya Myojin
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Katsuki Okada
- Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tatsuya Noda
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Nara Medical University, Kashihara, Japan
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23
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Soeda T, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Hospital- and Patient-Level Analysis of Quality Indicators in Acute Coronary Syndrome Care: A Nationwide Database Study. Can J Cardiol 2022; 39:515-523. [PMID: 36503027 DOI: 10.1016/j.cjca.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to clarify the variations in the quality of care provided to patients with acute coronary syndrome (ACS) and to investigate the association between quality of care and mortality at both hospital and patient levels with the use of a nationwide database. METHODS Patients with ACS who underwent percutaneous coronary intervention (PCI) from April 2014 to March 2018 were included from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Twelve quality indicators (QIs) available from administrative data and the association of the QIs with all-cause mortality were investigated. RESULTS From the analysis of 216,436 patients from 1215 hospitals, adherence to PCI on admission day, aspirin use on arrival, P2Y12 inhibitor use, and left ventricular function assessment were high (median proportion > 90%), and adherence to outpatient cardiac rehabilitation was low (median proportion < 10%). At the hospital level, acute-phase composite QI score was associated with reduced risk-adjusted 30-day mortality (β = -0.92 [95% confidence interval -1.19 to -0.65]; P < 0.001). At the patient level, all acute-phase and subacute-phase QIs were inversely associated with 30-day and 2-year mortalities, respectively (all P < 0.001). CONCLUSIONS Substantial variations in ACS care were observed in the current nationwide database. High adherence to the QI sets was associated with significant survival gains at both hospital and patient levels. Multilevel approach in QI assessment may be effective for improvement of survival in this population.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan.
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24
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Tonegawa-Kuji R, Inoue YY, Nakai M, Kanaoka K, Sumita Y, Miyazaki Y, Wakamiya A, Shimamoto K, Ueda N, Nakajima K, Kataoka N, Wada M, Yamagata K, Ishibashi K, Miyamoto K, Nagase S, Aiba T, Miyamoto Y, Iwanaga Y, Kusano K. Clinical Predictors of Pacing Device Implantation in Implantable Cardiac Monitor Recipients for Unexplained Syncope. CJC Open 2022; 5:259-267. [PMID: 37124961 PMCID: PMC10140738 DOI: 10.1016/j.cjco.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Implantable cardiac monitors (ICMs) help investigate the cause of unexplained syncope, but the probability and predictors of needing a pacing device thereafter remain unclear. Methods We retrospectively analyzed the data of patients who received ICM insertion for unexplained syncope with suspected arrhythmic etiology. The data were obtained from a nationwide database obtained between April 1, 2012 and March 31, 2020. Multivariable mixed-effects survival analysis was performed to identify predictors of pacing device implantation (PDI), and a risk score model was developed accordingly. Results In total, 2905 patients (age: 72 years [range: 60-78]) implanted with ICMs to investigate the cause of syncope were analyzed. During the median follow-up period of 128 days (range: 68-209) days, 473 patients (16%) underwent PDI. Older age, history of atrial fibrillation, bundle branch block (BBB), and diabetes were independent predictors of PDI in multivariable analysis. A risk score model was developed with scores ranging from 0 to 32 points. When patients with the lowest quartile score (0-13 points) were used as a reference, those with higher quartiles had a higher risk of PDI (second quartile: 14-15 points, hazard ratio [HR]: 3.86, 95% confidence interval [CI]: 2.62-5.68; third quartile: 16-18 points, HR: 4.67, 95% CI: 3.14-6.94; fourth quartile: 19-32 points, HR: 6.59, 95% CI: 4.47-9.71). Conclusions The 4 identified predictors are easily assessed during the initial evaluation of patients with syncope. They may help identify patients with a higher risk of requiring permanent PDI.
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25
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Miyamoto K, Kanaoka K, Ohta Y, Yoh M, Takahashi H, Tonegawa‐Kuji R, Miyazaki Y, Shimamoto K, Wakamiya A, Ueda N, Nakajima K, Kamakura T, Wada M, Ishibashi K, Inoue Y, Nagase S, Aiba T, Narai A, Nakase T, Koga M, Fukuda T, Kataoka N, Takagi M, Kusano K. A multicenter prospective randomized study comparing the incidence of periprocedural cerebral embolisms caused by catheter ablation of atrial fibrillation between cryoballoon and radiofrequency ablation (Embo-Abl study): Study design. Clin Cardiol 2022; 46:214-222. [PMID: 36413635 PMCID: PMC9933100 DOI: 10.1002/clc.23949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/03/2022] [Accepted: 10/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although catheter ablation (CA) has become a standard therapeutic approach to atrial fibrillation (AF), it imposes a low but relevant risk of thromboembolic complications of around 0.5%-1%, including ischemic strokes, and has an additional risk of clinically silent cerebral embolisms (SCEs) of 10%-40%. Both cryoballoon (CB) and radiofrequency (RF) ablation are routinely used clinically worldwide, yet there are few prospective data comparing the incidence of cerebral embolism after CA of AF between CB and RF ablation. METHODS The aim of the Embo-Abl study will be to compare the incidence of cerebral embolisms on 3 T diffusion-weighted image magnetic resonance imaging (MRI) after CA of AF between CB and RF ablation in patients with AF in a prospective, multicenter, open-label, controlled, randomized fashion. The primary endpoint of the Embo-Abl study will be the occurrence of MRI-detected SCE 1-3 days after CA. The patients will be registered and randomly assigned to either the CB or RF ablation group in a 1:1 ratio. The study cohort will include 230 patients with AF from a multicenter in Japan. RESULTS The results of this study are currently under investigation. CONCLUSION The Embo-Abl study will be the first to compare the incidence of periprocedural cerebral embolisms caused by CA of AF between CB and RF ablation in a prospective, multicenter, randomized, controlled fashion.
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Affiliation(s)
- Koji Miyamoto
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Koshiro Kanaoka
- Center for Cerebral and Cardiovascular Disease Information, Open Innovation CenterNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Yasutoshi Ohta
- Department of RadiologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Masue Yoh
- Department of Medicine IIKansai Medical UniversityMoriguchiJapan
| | - Hiroki Takahashi
- Department of Medicine IIKansai Medical UniversityMoriguchiJapan
| | - Rena Tonegawa‐Kuji
- Center for Cerebral and Cardiovascular Disease Information, Open Innovation CenterNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Yuichiro Miyazaki
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Keiko Shimamoto
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Akinori Wakamiya
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Nobuhiko Ueda
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Kenzaburo Nakajima
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Tsukasa Kamakura
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Mitsuru Wada
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Kohei Ishibashi
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Yuko Inoue
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Satoshi Nagase
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Takeshi Aiba
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Akihisa Narai
- New Development GroupHashimoto Electronic Industry Co., LtdMatsusakaJapan
| | - Tomohiro Nakase
- New Development GroupHashimoto Electronic Industry Co., LtdMatsusakaJapan
| | - Masatoshi Koga
- Department of Cerebrovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Tetsuya Fukuda
- Department of RadiologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Naoya Kataoka
- Second Department of Internal MedicineUniversity of ToyamaToyamaJapan
| | - Masahiko Takagi
- Department of Medicine IIKansai Medical UniversityMoriguchiJapan
| | - Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
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26
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Multifactorial Effects of Outpatient Cardiac Rehabilitation in Patients with Heart Failure: A Nationwide Retrospective Cohort Study. Eur J Prev Cardiol 2022; 30:zwac274. [PMID: 36378557 DOI: 10.1093/eurjpc/zwac274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Abstract
AIM Although cardiac rehabilitation (CR) is a strongly recommended therapy, no large study has assessed the effects of outpatient CR in patients with heart failure (HF) in real-world settings. Therefore, this study aimed to investigate the multifactorial effects of outpatient CR in patients with HF using a nationwide database. METHODS AND RESULTS This nationwide retrospective cohort study was performed using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with acute HF who underwent inpatient CR between April 2014 and March 2020 were included. The association between outpatient CR participation and all-cause mortality, rehospitalisation for HF, use of medical resources, and medical costs was analysed using propensity score matching analysis. Of 250,528 patients, 17,884 (7.1%) underwent outpatient CR. After propensity score matching, the CR (+) group was associated with a reduction in the risk of all-cause mortality (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.60-0.68, p < 0.001) and rehospitalisation for HF compared to the CR (-) group (HR: 0.87, 95% CI: 0.82-0.92, p < 0.001). The proportion of guideline-based medication use for HF at 1 year was higher in the CR (+) group than in the CR (-) group. The total medical costs from the index hospitalisation to 1.5 years after admission were similar between the groups. CONCLUSION Outpatient CR participation after discharge from HF was associated with reduced mortality and rehospitalisation for HF without increasing medical costs.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
- Department of Biostatistics, National Cerebral and Cardiovascular Center
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
- Department of Medical Informatics, Osaka University Graduate School of Medicine
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
- Nara Prefecture Seiwa Medical Center
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University
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Sezai A, Shimokawa T, Kanaoka K, Fukuma N, Sekino H, Shiraishi H, Sumita Y, Nakai M, Iwanaga Y, Furukawa Y, Miura SI, Oya Y, Yasu T, Makita S. Efficacy of Early Cardiac Rehabilitation After Cardiac Surgery - Verification Using Japanese Diagnosis Procedure Combination Data. Circ Rep 2022; 4:505-516. [PMID: 36408360 PMCID: PMC9638512 DOI: 10.1253/circrep.cr-22-0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 10/31/2023] Open
Abstract
Background: The current status of cardiac rehabilitation (CR) after cardiac surgery and the introduction of early CR (E-CR) in Japan are not fully understood. In this study, the current status of E-CR and its efficacy were investigated by the Academic Committee of the Japanese Association of Cardiac Rehabilitation. Methods and Results: We examined the rate of introduction of E-CR and its effects among 220,122 patients who underwent major cardiac and thoracic vascular surgery, as registered in the Diagnosis Procedure Combination (DPC) classification system, between April 2012 and March 2018. In this study, E-CR was defined as CR starting within 1 day after surgery. Patients with and without E-CR were propensity score matched and analyzed for clinical outcomes. Of all patients participating in CR after surgery, E-CR was initiated in 52.1%, 56.9%, 47.4%, and 54.1% of patients undergoing coronary artery bypass grafting, valve surgery, aortic surgery, and other cardiovascular surgery, respectively. After propensity score matching, outcomes for E-CR were significantly superior to non-E-CR in terms of in-hospital deaths, Barthel Index score at discharge, length of hospital stay, and hospitalization costs. Conclusions: E-CR after cardiac surgery was effective in terms of prognosis, hospital stay, and medical costs. This study is the first report using big data in Japan. The results indicate that further introduction of E-CR needs to be recommended in the future.
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Affiliation(s)
- Akira Sezai
- Department of Cardiovascular Surgery, Nihon University School of Medicine Tokyo Japan
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute Tokyo Japan
- Department of Cardiovascular Surgery, Teikyo University School of Medicine Tokyo Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center Osaka Japan
| | - Nagaharu Fukuma
- The Faculty of Rehabilitation and Care, Seijoh University Aichi Japan
| | | | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center Osaka Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center Osaka Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center Osaka Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital Hyogo Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine Fukuoka Japan
| | - Yusuke Oya
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of The Ryukyus Okinawa Japan
| | - Takanori Yasu
- Department of Cardiovascular Medicine, Dokkyo Medical University Nikko Medical Center Tochigi Japan
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University Saitama Japan
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28
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Tonegawa-Kuji R, Kanaoka K, Mori M, Nakai M, Iwanaga Y. Mortality and 30-Day Readmission Rates After Inpatient Leadless Pacemaker Implantation: Insights From a Nationwide Readmissions Database. Can J Cardiol 2022; 38:1697-1705. [PMID: 35963501 DOI: 10.1016/j.cjca.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study aimed to provide real-world data on the rates, trends, and predictors of in-hospital complications and 30-day readmission following leadless pacemaker (LP) implantation. METHODS We analysed leadless and conventional pacemaker implantations with the use of the all-payer, nationally representative Nationwide Readmissions Database from 2017 to 2019. The national trends of in-hospital mortality, in-hospital complications, and 30-day readmission rates after pacemaker implantation were analysed. Mixed-effects multivariable logistic regression analysis was performed to identify factors associated with in-hospital death and 30-day readmission in LP patients. RESULTS A total of 137,732 admissions (age 78 years, IQR 70-85 years, 5986 LP implantations) were analysed. The in-hospital mortality, overall in-hospital complication, and 30-day readmission rates after LP implantations were 5.0%, 16%, and 16%, respectively. In LP recipients, the national estimate of in-hospital mortality declined from 10.9% in the second quarter of 2017 to 4.3% in the fourth quarter of 2019 (P < 0.001). Furthermore, the national estimate of overall complications declined from 20.6% in the second quarter of 2017 to 13.0% in the fourth quarter of 2019 (P < 0.001). In LP recipients, female sex, history of chronic kidney disease, heart failure, and malnutrition were factors associated with in-hospital death. CONCLUSIONS Analysis of the nationally representative claims database from the United States showed in-hospital mortality and complication rates (for LP implantation performed during hospitalisation) of 5.0% and 16%, respectively. Although these rates showed a decreasing trend over time, ongoing surveillance is needed for the safety of LP implantation.
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Affiliation(s)
- Reina Tonegawa-Kuji
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Centre, Suita, Japan.
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Makoto Mori
- Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Centre, Suita, Japan
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29
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Nakai M, Iwanaga Y, Kanaoka K, Sumita Y, Nishioka Y, Myojin T, Kubo S, Okada K, Soeda T, Noda T, Sakata Y, Imamura T, Saito Y, Yasuda S, Miyamoto Y. Age-dependent association of discharge heart-failure medications with clinical outcomes in a super-aged society. Biomed Pharmacother 2022; 155:113761. [DOI: 10.1016/j.biopha.2022.113761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022] Open
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30
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Tonegawa-Kuji R, Kanaoka K, Mori M, Nakai M, Iwanaga Y. Mortality and 30-day readmission rate following leadless pacemaker implantation: insights from the Nationwide Readmissions Database. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Clinical trials and registry data showed encouraging outcomes for leadless pacemaker (LP) implantation. However, reports of patient characteristics, trends, and clinical outcomes in a real-world population are limited.
Purpose
To provide real-world evidence of the rates, trends, and patient characteristics associated with in-hospital complications and 30-days readmission after LP implantations.
Methods
Using the all-payer, nationally representative Nationwide Readmissions Database between 2017 and 2019, we analyzed leadless or conventional pacemaker implantations. The national trends of in-hospital mortality, in-hospital complication rates and 30-day readmission rates after pacemaker implantation and their national trends were analyzed. Mixed-effects multivariable logistic regression analysis was performed to identify factors associated with in-hospital death and 30-days readmission in LP patients.
Results
A total of 137,732 admissions (age: 78 [70–85], 5,986 LP implantations) were analyzed (Figure 1). The in-hospital mortality, overall in-hospital complication rate, and 30-days readmission rates after LP implantations were 5.0%, 16%, and 16%, respectively. In LP recipients, the national estimate of in-hospital mortality declined from 10.9% in the second quarter of 2017 to 4.3% in the fourth quarter of 2019 (P<0.001) (Figure 2a). Furthermore, the national estimate of overall complication rate declined from 20.6% in the second quarter of 2017 to 13.0% in the fourth quarter of 2019 (P<0.001) (Figure 2b). Conversely, non-elective 30-day readmission rate did not show any increasing or decreasing trends in LP recipients (P=0.74) (Figure 2c). In LP recipients, female sex (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.04–1.93), history of heart failure (OR 2.02, 95% CI 1.46–2.79), and first quartile annual pacemaker implantation hospital volume (OR 2.49, 95% CI 1.56–3.97, fourth quartile annual pacemaker implantation hospital volume used as a reference standard) were factors associated with in-hospital death.
Conclusions
Analysis of the nationally representative claims database in the US showed in-hospital mortality, complication rates, and non-elective 30-day readmission rate of 5.0%, 16%, and 16% respectively, for LP implantation performed during hospitalization. Although in-hospital mortality and complication rates showed a decreasing trend over time, ongoing surveillance is needed for the safety of LP implantation.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Intramural research fund (21-6-9)for cardiovascular diseases of national cerebral and cardiovascular center.
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Affiliation(s)
- R Tonegawa-Kuji
- National Cerebral & Cardiovascular Center, Department of Medical and Health Information Management , Suita , Japan
| | - K Kanaoka
- National Cerebral & Cardiovascular Center, Department of Medical and Health Information Management , Suita , Japan
| | - M Mori
- Yale University, Section of Cardiovascular surgery , New Haven , United States of America
| | - M Nakai
- National Cerebral & Cardiovascular Center, Department of Medical and Health Information Management , Suita , Japan
| | - Y Iwanaga
- National Cerebral & Cardiovascular Center, Department of Medical and Health Information Management , Suita , Japan
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31
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Kusano K, Yamane T, Inoue K, Takegami M, Nakao YM, Nakai M, Kanaoka K, Tonegawa‐Kuji R, Miyamoto K, Iwasaki Y, Takatsuki S, Nakamura K, Iwanaga Y, Shimizu W. The Japanese Catheter Ablation Registry (J‐AB): Annual report in 2020. J Arrhythm 2022; 38:675-681. [PMID: 36237868 PMCID: PMC9535794 DOI: 10.1002/joa3.12772] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kengo Kusano
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Teiichi Yamane
- Division of Cardiology, Department of Internal Medicine The Jikei University School Minato‐ku Tokyo Japan
| | - Koichi Inoue
- Cardiovascular Division National Hospital Organization Osaka National Hospital Osaka Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology National Cerebral and Cardiovascular Center Suita Japan
| | - Yoko M. Nakao
- Center for Cerebral and Cardiovascular Disease Information Open Innovation Center, National Cerebral and Cardiovascular Center Suita Japan
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information Open Innovation Center, National Cerebral and Cardiovascular Center Suita Japan
| | - Koshiro Kanaoka
- Center for Cerebral and Cardiovascular Disease Information Open Innovation Center, National Cerebral and Cardiovascular Center Suita Japan
| | - Reina Tonegawa‐Kuji
- Center for Cerebral and Cardiovascular Disease Information Open Innovation Center, National Cerebral and Cardiovascular Center Suita Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Yu‐ki Iwasaki
- Department of Cardiovascular Medicine Nippon Medical School Bunkyo‐ku Japan
| | - Seiji Takatsuki
- Department of Cardiology Keio University School of Medicine Shinjuku‐ku Japan
| | - Kohki Nakamura
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yoshitaka Iwanaga
- Center for Cerebral and Cardiovascular Disease Information Open Innovation Center, National Cerebral and Cardiovascular Center Suita Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Nippon Medical School Bunkyo‐ku Japan
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32
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Ogawa M, Yoshida N, Nakai M, Kanaoka K, Sumita Y, Kanejima Y, Emoto T, Saito Y, Yamamoto H, Sakai Y, Hirota Y, Ogawa W, Iwanaga Y, Miyamoto Y, Yamashita T, Izawa KP, Hirata KI. Hospital-associated disability and hospitalization costs for acute heart failure stratified by body mass index- insight from the JROAD/JROAD-DPC database. Int J Cardiol 2022; 367:38-44. [PMID: 36029847 DOI: 10.1016/j.ijcard.2022.08.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/13/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The impact of body mass index (BMI) on hospital mortality in patients with acute heart failure has been well documented in Asian populations. However, the relationship between BMI, hospital-associated disability (HAD), and hospitalization costs in patients with heart failure is poorly understood. This study aimed to explore the impact of BMI on HAD and hospitalization costs for acute heart failure in Japan. METHODS From April 2012 to March 2020, the Japanese Registry of All Cardiac and Vascular Disease Diagnosis Procedure Combination (JROAD-DPC) database was used to identify patients with acute heart failure. All patients were categorized into five groups according to the World Health Organization Asian BMI criteria. The hospitalization costs and HAD were evaluated. RESULTS Among the 238,160 eligible patients, 15.7% were underweight, 42.2% were normal, 16.7% were overweight, 19.3% were obese I, and 6.0% were obese II, according to BMI. The prevalence of HAD was 7.43% in the total cohort, and the risk of HAD increased with a lower BMI. Restricted cubic spline analysis showed a U-shaped relationship between BMI and hospitalization costs for all ages. Furthermore, developing HAD was associated with greater costs compared with non-HAD, regardless of BMI category. CONCLUSIONS We found that the lower the BMI, the higher the incidence of HAD. A U-shaped association was confirmed between BMI and hospitalization costs, indicating that hospitalization costs increased for both lower and higher BMI regardless of age. BMI could be an important and informative risk stratification tool for functional outcomes and economic burdens.
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Affiliation(s)
- Masato Ogawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Hyogo, Japan; Division of Rehabilitation Medicine, Kobe University Hospital, Hyogo, Japan
| | - Naofumi Yoshida
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan; Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Biostatistics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuji Kanejima
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Hyogo, Japan
| | - Takuo Emoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yoshihiro Saito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hiroyuki Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoya Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Hyogo, Japan.
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
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33
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Nakai M, Iwanaga Y, Kanaoka K, Sumita Y, Nishioka Y, Myojin T, Kubo S, Okada K, Soeda T, Noda T, Sakata Y, Imamura T, Saito Y, Yasuda S, Miyamoto Y. Contemporary use of SGLT2 inhibitors in heart failure patients with diabetes mellitus: a comparison of DPP4 inhibitors in a nationwide electric health database of the superaged society. Cardiovasc Diabetol 2022; 21:157. [PMID: 35964039 PMCID: PMC9375946 DOI: 10.1186/s12933-022-01586-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a lack of recent data reflecting the actual use of sodium-glucose cotransporter-2 (SGLT2) inhibitors for heart failure (HF) and type 2 diabetes (DM) in the superaged society. The present study investigated the association between the use of SGLT2 inhibitors and one-year prognosis in patients hospitalized across a broad spectrum of HF patients with DM in the superaged society using the Nationwide Electric Health Database in Japan. METHODS The patients hospitalized with the first episode of acute HF were identified from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2019. A cohort of 2,277 users of SGLT2 inhibitors and 41,410 users of the active comparator, dipeptidyl peptidase-4 (DPP4) inhibitors were compared. A propensity score-matched cohort study of 2,101 users of each inhibitor was also conducted. A multivariable multilevel mixed-effects survival model was conducted with adjustments, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. RESULTS Among 300,398 patients discharged with HF in 4,176 hospitals, 216,016 (71.9%) were 75 years or older, and 60,999 (20.3%) took antidiabetic medications. Among them, the patients treated with SGLT2 inhibitors were younger and had a more severe status than those treated with DPP4 inhibitors. Kaplan-Meier analysis showed that patients treated with SGLT2 inhibitors had a lower mortality risk and HF readmission. In propensity-matched cohorts, SGLT2 inhibitor use was associated with a lower risk of mortality and HF readmission than DPP-4 inhibitor use (HR [95% CI]; 0.70 [0.56, 0.89] and 0.52 [0.45, 0.61], respectively). Very elderly (≥ 75 years) patients showed similar results. Favorable effects were also observed across all age groups, including ≥ 75 years, in patients with coronary artery disease or atrial fibrillation and with concomitant β-blocker, diuretics, or insulin. CONCLUSION The use of SGLT2 inhibitors at discharge was associated with a lower risk of one-year mortality and HF readmission in patients across a broad spectrum of HF with DM in the superaged society. The findings further support the benefits of using SGLT2 inhibitors in very elderly HF care and complement the current evidence.
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Affiliation(s)
- Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Japan.,Department of Biostatistics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Japan.
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Hospital, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Japan
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Kanaoka K, Iwanaga Y, Tsujimoto Y, Shiroshita A, Suzuki T, Nakai M, Miyamoto Y. Quality indicators for acute cardiovascular diseases: a scoping review. BMC Health Serv Res 2022; 22:862. [PMID: 35790957 PMCID: PMC9254543 DOI: 10.1186/s12913-022-08239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/23/2022] [Indexed: 01/06/2023] Open
Abstract
Abstract
Background
Although many quality indicator (QI) sets have been developed for acute cardiovascular diseases, a comprehensive summary is lacking. In this scoping review we aimed to summarize the available evidence on the QI sets for acute cardiovascular diseases, and assess the QI set development process. We followed the Joanna Briggs Institute framework and the PRISMA extension for scoping reviews.
Methods
We conducted a systematic search of MEDLINE, EMBASE, and major international guidelines on QIs for acute major cardiovascular diseases. The study included articles published after 2000.
Results
Among the 3112 articles screened, 18 were included in this scoping review. Among the 18 articles included, 12 were on acute coronary syndrome (ACS), five on acute heart failure (AHF), and two on acute aortic dissection (AAD); one article included QIs for both ACS and AHF. Only four of these studies conducted a systematic search with a search strategy. From the 18 articles, 268 QIs containing duplication between articles were identified (191 QIs were for ACS, 57 were for AHF, and 20 were for AAD) and QI measurements varied across articles.
Conclusions
This scoping review provides a comprehensive list of QIs for acute cardiovascular diseases. Our results may be helpful to clinicians and organizations seeking to develop QIs for acute cardiovascular care in the future.
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Kanaoka K, Iwanaga Y, Fukuma N, Nakai M, Sumita Y, Nishioka Y, Okada K, Noda T, Sakata Y, Imamura T, Miyamoto Y. Trends and Factors Associated With Cardiac Rehabilitation Participation ― Data From Japanese Nationwide Databases ―. Circ J 2022; 86:1998-2007. [DOI: 10.1253/circj.cj-22-0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Nagaharu Fukuma
- School of Nursing, Japanese Red Cross Toyota College of Nursing Toyota Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Katsuki Okada
- Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University
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Ishihara S, Hiramitsu S, Kanaoka K, Taki M, Nakagawa H, Ueda T, Seno A, Nishida T, Onoue K, Soeda T, Ohtani T, Watanabe M, Kawakami R, Sakata Y, Kario K, Saito Y. New Conversion Formula Between B-Type Natriuretic Peptide and N-Terminal-Pro-B-Type Natriuretic Peptide - Analysis From a Multicenter Study. Circ J 2022; 86:2010-2018. [PMID: 35613887 DOI: 10.1253/circj.cj-22-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although B-type natriuretic peptide (BNP) and N-terminal (NT)-proBNP are commonly used markers of heart failure, a simple conversion formula between these peptides has not yet been developed for clinical use.Methods and Results: A total of 9,394 samples were obtained from Nara Medical University, Jichi Medical University, and Osaka University. We randomly selected 70% for a derivation set to investigate a conversion formula from BNP to NT-proBNP using estimated glomerular filtration rate (eGFR) and body mass index (BMI); the remaining 30% was used as the internal validation set and we used a cohort study from Nara Medical University as an external validation set. Multivariate linear regression analysis revealed a new conversion formula: log NT-proBNP = 1.21 + 1.03 × log BNP - 0.009 × BMI - 0.007 × eGFR (r2=0.900, P<0.0001). The correlation coefficients between the actual and converted values of log NT-proBNP in the internal and external validation sets were 0.942 (P<0.0001) and 0.891 (P<0.0001), respectively. We applied this formula to samples obtained from patients administered with sacubitril/valsartan. After treatment initiation, NT-proBNP levels decreased and actual BNP levels increased. However, the calculated BNP levels decreased roughly parallel to the NT-proBNP levels. CONCLUSIONS This new and simple conversion formula of BNP and NT-proBNP with eGFR and BMI is potentially useful in clinical practice.
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Affiliation(s)
- Satomi Ishihara
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University
| | - Mizuri Taki
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | | | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Ayako Seno
- Department of Cardiovascular Medicine, Nara Medical University
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
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Tonegawa-Kuji R, Inoue Y, Kanaoka K, Nakai M, Iwanaga Y, Kusano KF. PO-647-06 CLINICAL PREDICTORS OF PACING DEVICE IMPLANTATION IN PATIENTS WHO RECEIVED AN IMPLANTABLE CARDIAC MONITOR FOR UNEXPLAINED SYNCOPE: ANALYSIS USING THE JROAD-DPC DATABASE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kanaoka K, Nishida T, Nishioka Y, Myojin T, Kubo S, Soeda T, Okada K, Noda T, Iwanaga Y, Miyamoto Y, Sakata Y, Imamura T, Saito Y. The impact of hospital case volume on the outcomes after catheter ablation for atrial fibrillation according to the ablation technology. J Cardiovasc Electrophysiol 2022; 33:1394-1402. [PMID: 35437814 DOI: 10.1111/jce.15495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The appropriate hospital case volume for catheter ablation (CA) in patients with atrial fibrillation (AF) according to the ablation technology has not been fully examined. This study aimed to investigate the association between the hospital case volume for AF and periprocedural complications and AF recurrence. METHODS In this retrospective cohort study, we used data from the National Database of Health Insurance Claims and Specific Health Checkups, which covers almost all healthcare insurance claims data in Japan. We included patients with AF who underwent first-time CA from April 2014 to March 2020. Using mixed-effect logistic regression, we analyzed the effect of the annual case volume for AF ablation on acute periprocedural complications and 1-year success rate off antiarrhythmic drugs according to the ablation technology (radiofrequency ablation or cryoballoon ablation). RESULTS Among 270 116 patients, 207 839 (77%) patients underwent radiofrequency ablation and 56 648 (21%) patients underwent cryoballoon ablation. Of all patients, acute complications occurred in 5411 (2.0%) patients, and the recurrence at 1 year was 71 511 (27%). In the radiofrequency ablation group, acute complications and 1-year AF recurrence according to case volume decreased as the annual case volume increased to up to 150-200 cases/year. However, in the cryoballoon ablation group, these outcomes were similar regardless of the case volumes. CONCLUSION The case-volume effect was noted in the radiofrequency ablation group, but not in the cryoballoon ablation group. Our results may affect the selection of ablation technology, especially in smaller case-volume hospitals.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.,Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yuichi Nishioka
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsuya Noda
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomoaki Imamura
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
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Terasaki S, Kanaoka K, Saito Y. Response to: Correspondence on 'Outcomes of catecholamine and/or mechanical support in Takotsubo syndrome' by John E Madias. Heart 2022; 108:986-987. [DOI: 10.1136/heartjnl-2022-320925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Terasaki S, Kanaoka K, Nakai M, Sumita Y, Onoue K, Soeda T, Watanabe M, Miyamoto Y, Saito Y. Outcomes of catecholamine and/or mechanical support in Takotsubo syndrome. Heart 2022; 108:1467-1473. [DOI: 10.1136/heartjnl-2021-319904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/07/2021] [Indexed: 12/14/2022] Open
Abstract
ObjectiveThis study aimed to reveal the clinical characteristics of patients with severe Takotsubo syndrome (TTS) who needed catecholamine support (CS) or mechanical support (MS) and to identify factors associated with serious illness and in-hospital mortality.MethodsThis was a nationwide retrospective study that used claims data from the Japanese registry of all cardiac and vascular diseases and the diagnosis procedure combination registry, from April 2012 to March 2016. The patients with TTS were divided into severe TTS and mild TTS groups. The severe group was defined as patients who needed CS and/or MS.ResultsAmong 6169 patients with TTS, 1148 (18.6%) had severe TTS. No significant difference in age was found between the two groups; however, the number of female patients was significantly lower in the severe group than in the mild group. Among 130 patients who underwent MS, 22 and 108 patients required MS alone and both MS and CS, respectively. The 30-day mortality rate was significantly higher in the severe group than in the mild group (11.4% vs 2.6%, p<0.01) and increased with age. Of the patients with severe TTS, 65.6% died within 7 days. Multivariable analysis showed that male sex (OR 1.22, p=0.03), higher Charlson scores (OR 1.11, p<0.01), comorbid pneumonia (OR 1.68, p<0.01), comorbid sepsis (OR 6.02, p<0.01) and ambulance use (OR 2.01, p<0.01) were associated with severe TTS.ConclusionsThe rate of severe TTS was 18.6% among 6169 patients registered in the Japanese nationwide database, and the 30-day mortality was higher in patients with severe TTS than in those with mild TTS (11.4% vs 2.6%).
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Yano H, Nishida T, Sugiura J, Keshi A, Kanaoka K, Terasaki S, Hashimoto Y, Nakada Y, Nakagawa H, Ueda T, Seno A, Onoue K, Watanabe M, Saito Y. Incidence of epicardial connections between the right pulmonary vein carina and right atrium during catheter ablation of atrial fibrillation: A comparison between the conventional method and unipolar signal modification. J Arrhythm 2021; 38:97-105. [PMID: 35222755 PMCID: PMC8851570 DOI: 10.1002/joa3.12672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 11/11/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Hiroki Yano
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Junichi Sugiura
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Ayaka Keshi
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Koshiro Kanaoka
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Satoshi Terasaki
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Yasuki Nakada
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Hitoshi Nakagawa
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Ayako Seno
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Kenji Onoue
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine Nara Medical University Kashihara Japan
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Kusano K, Yamane T, Inoue K, Takegami M, Nakao YM, Nakai M, Kanaoka K, Miyamoto K, Iwasaki Y, Takatsuki S, Nakamura K, Miyamoto Y, Shoda M, Nogami A, Shimizu W. The Japanese Catheter Ablation Registry (J-AB): Annual report in 2019. J Arrhythm 2021; 37:1443-1447. [PMID: 34887948 PMCID: PMC8637092 DOI: 10.1002/joa3.12640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/02/2021] [Accepted: 09/18/2021] [Indexed: 11/10/2022] Open
Abstract
The Japanese Catheter Ablation (J-AB) registry, started in August 2017, is a voluntary, nationwide, multicenter, prospective, observational registry, performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center using a Research Electronic Data Capture system. The purpose of this registry is to collect the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in the real-world settings. During the year of 2019, we have collected a total of 80 795 procedures (mean age of 65.2 years and 66.4% male) from 425 participant hospitals. Detailed data are shown in Figures and Tables.
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Affiliation(s)
- Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Teiichi Yamane
- Division of Cardiology Department of Internal MedicineThe Jikei University School of Medicine TokyoTokyoJapan
| | - Koichi Inoue
- Cardiovascular DivisionNational Hospital Organization Osaka National Hospital OsakaOsakaJapan
| | - Misa Takegami
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular Center SuitaSuitaJapan
| | - Yoko M. Nakao
- Center for Cerebral and Cardiovascular Disease InformationOpen Innovation CenterNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease InformationOpen Innovation CenterNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Koshiro Kanaoka
- Center for Cerebral and Cardiovascular Disease InformationOpen Innovation CenterNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Koji Miyamoto
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Seiji Takatsuki
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Kohki Nakamura
- Department of CardiologyGunma Prefectural Cardiovascular CenterTokyoJapan
| | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease InformationOpen Innovation CenterNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Morio Shoda
- Clinical Research Division of Heart Rhythm ManagementDepartment of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
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Nishida T, Takitsume A, Sugiura J, Keshi A, Kanaoka K, Hirai K, Yano H, Hashimoto Y, Ueda T, Nakagawa H, Onoue K, Soeda T, Watanabe M, Kawakami R, Saito Y. Catheter ablation of ganglionated plexi in patients with adenosine triphosphate-induced atrial fibrillation after pulmonary vein isolation. Heart Vessels 2021; 37:854-866. [PMID: 34741632 DOI: 10.1007/s00380-021-01979-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Abstract
Intravenous ATP may induce atrial fibrillation (AF). ATP shares similar receptor-effector coupling systems with acetylcholine. However, the association between an ATP injection and the hyperactivity of the intrinsic cardiac autonomic nervous system, known as ganglionated plexi (GPs), is not well understood. We describe a series of patients with non-pulmonary vein (PV) trigger sites provoked by an ATP injection, and assess the feasibility of a ganglionated plexus (GP) ablation. We retrospectively analyzed 547 patients (69% male; mean age 67.4 ± 10.4 years; 38.5% non-paroxysmal AF) who underwent a total of 604 ablation procedures. Intravenous ATP was administered with an isoproterenol infusion during sinus rhythm after a pulmonary vein isolation in 21.3%, Box isolation in 78.6%, and SVC isolation in 52.0% of the procedures, respectively. We reviewed the incidence, the distribution of the foci, and the ablation outcomes in patients with ATP-induced AF. A total of seven patients (1.3%) had ATP-induced AF. Foci were identified in the coronary sinus (CS) in six patients, right atrial posterior wall (RAPW) adjacent to the interatrial groove in two, mitral annulus in two, ligament of Marshall in one, right septum below the foramen ovale in one and left atrial posterior wall in one, respectively. Among these trigger foci, we confirmed the vagal response by high-frequency stimulation in the CS and RAPW in six and two patients, respectively. After a median RF time of 2.9 min (range 2.5-11.3) targeting these foci, in five of six patients who received a repeat ATP injection, the AF became non-inducible. ATP-provoked trigger foci were distributed among certain sites that overlapped with the distribution of the GPs. The GP ablation was effective for this rare, but challenging situation.
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Affiliation(s)
- Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan.
| | - Akihiro Takitsume
- Department of Cardiology, Nara Prefecture General Medical Center, Kashihara, Japan
| | - Junichi Sugiura
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Ayaka Keshi
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Kaeko Hirai
- Department of Cardiology, Nara Prefecture Seiwa Medical Center, Kashihara, Japan
| | - Hiroki Yano
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Hitoshi Nakagawa
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
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Onoue K, Nakagawa H, Keshi A, Sugiura J, Okamura A, Kanaoka K, Kyodo A, Terasaki S, Nakamura T, Yano H, Nogi K, Ishihara S, Hashimoto Y, Ueda T, Seno A, Nishida T, Soeda T, Watanabe M, Kawakami R, Saito Y. Overview of the 85 th Annual Scientific Meeting of the Japanese Circulation Society - NEXT STAGE; Future of Medicine and Community. Circ J 2021; 85:2121-2127. [PMID: 34615816 DOI: 10.1253/circj.cj-21-0735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Ayaka Keshi
- Department of Cardiovascular Medicine, Nara Medical University
| | - Junichi Sugiura
- Department of Cardiovascular Medicine, Nara Medical University
| | - Akihiko Okamura
- Department of Cardiovascular Medicine, Nara Medical University
| | - Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University
| | - Atsushi Kyodo
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Takuya Nakamura
- Department of Cardiovascular Medicine, Nara Medical University
| | - Hiroki Yano
- Department of Cardiovascular Medicine, Nara Medical University
| | - Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University
| | - Satomi Ishihara
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Ayako Seno
- Department of Cardiovascular Medicine, Nara Medical University
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
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Kataoka Y, Anan K, Taito S, Tsujimoto Y, Kurata Y, Wada Y, Maruta M, Kanaoka K, Oide S, Takahashi S, Nango E. Quality of clinical practice guidelines in Japan remains low: A cross-sectional meta-epidemiological study. J Clin Epidemiol 2021; 138:22-31. [PMID: 34217818 DOI: 10.1016/j.jclinepi.2021.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/13/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to evaluate the characteristics, quality, and related factors of the Japanese Clinical Practice Guidelines (CPGs) published in recent years. STUDY DESIGN AND SETTING In this cross-sectional, meta-epidemiological study, we conducted a Google search for CPGs published by 30 Japanese medical societies that are the basis for training specialties between 2018 and 2019. We used the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool and the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement to evaluate the quality. RESULTS We included 53 systematic review-based CPGs. The median score was 0.54 (IQR, 0.38-0.62) for Stakeholder involvement, 0.57 (IQR, 0.51-0.66) in Rigor of development, 0.33 (IQR 0.21-0.46) in Applicability, and 0.63 (IQR 0.46-0.73) in Editorial independence. The number of guideline developers/clinical question ratio (odds ratio [OR]: 4.14, 95% confidence interval [CI]: 1.97, 8.70) and the adopted guideline development methods (OR: 3.69, 95% CI: 1.14, 12.0) were significantly related to the Rigor of development. CONCLUSION The quality of Japanese CPGs published in recent years remains low. Our study suggests that increasing contributors and adopting the latest guideline development methods at the beginning of the project may improve the quality of the Japanese CPGs.
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Affiliation(s)
- Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Tanaka Asukai-cho 89, Sakyo-ku, Kyoto, 606-8226, Japan; Department of Community Medicine in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan; Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Healthcare Epidemiology, Graduate School of Medicine / Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Keisuke Anan
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Healthcare Epidemiology, Graduate School of Medicine / Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Shunsuke Taito
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasushi Tsujimoto
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Nephrology and Dialysis, Kyoritsu Hospital, 16-5 Chuo-cho, Kawanishi, Hyogo, 666-0016, Japan; Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, JAPAN
| | - Yasuko Kurata
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Pharmacy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoshitaka Wada
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, 470-1192, Japan
| | - Masaki Maruta
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Hospital, Shitsukawa, Toon, 791-0295, Japan
| | - Koshiro Kanaoka
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Cardiovascular Medicine, Nara Medical University, 840, Shijo-cho, Kashihara-city, Nara, 634-8522, Japan
| | - Shiho Oide
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Gynecology, Women's center, Yotsuya Medical Cube, 7-7, Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Sei Takahashi
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of General Internal Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Eishu Nango
- Department of Family Medicine, Seibo International Catholic Hospital, 2-5-1 Naka-Ochiai, Shinjyuku-ku, Tokyo, 161-8521, Japan
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Mitsuya S, Tsuruoka K, Kanaoka K, Funamoto T, Tsuji H, Matsunaga N, Nakamura T, Tamura Y, Imanishi M, Ikeda S, Fujisaka Y, Goto I. P76.23 A Retrospective Study of Non-Small Cell Lung Cancer Treated with Second- and Third-Generation EGFR Tyrosine Kinase Inhibitors. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kanaoka K, Soeda T, Terasaki S, Nishioka Y, Myojin T, Kubo S, Okada K, Noda T, Watanabe M, Kawakami R, Sakata Y, Imamura T, Saito Y. Current Status and Effect of Outpatient Cardiac Rehabilitation After Percutaneous Coronary Intervention in Japan. Circ Rep 2021; 3:122-130. [PMID: 33738344 PMCID: PMC7956885 DOI: 10.1253/circrep.cr-20-0143] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background:
Although cardiac rehabilitation (CR) has been reported to be associated with better clinical outcomes in patients with cardiovascular diseases, there are few nationwide studies about CR participation by patients with coronary artery disease in Japan. Methods and Results:
We performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2018. Patients were divided into 2 groups (acute coronary syndrome [ACS] and stable coronary artery disease [sCAD]), and the rates of participation in in- and outpatient CR after percutaneous coronary intervention (PCI) were investigated. Propensity score-matched analysis was performed and the association between outpatient CR participation and all-cause mortality 3 months after PCI was examined. Overall, 616,664 patients (ACS, n=202,853; sCAD, n=413,811) were analyzed. The participation rates of CR increased annually. The participation rate was higher for inpatient than outpatient CR in both the ACS (52% vs. 9%, respectively) and sCAD (15% vs. 3%, respectively) groups. Prognosis was better for patients with than without outpatient CR in both the ACS (hazard ratio [HR] 0.52; 95% confidence interval [CI] 0.47–0.59) and sCAD (HR 0.72; 95% CI 0.65–0.80) groups. Conclusions:
Outpatient CR was associated with a better prognosis in patients with ACS or sCAD. The participation rates of outpatient CR following PCI were extremely low in Japan.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Satoshi Terasaki
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Osaka Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Osaka Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
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48
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Nakai M, Iwanaga Y, Sumita Y, Kanaoka K, Kawakami R, Ishii M, Uchida K, Nagano N, Nakayama T, Nishimura K, Tsuchihashi K, Kimura K, Saito Y, Tsujita K, Ogawa H, Miyamoto Y, Yasuda S. Validation of Acute Myocardial Infarction and Heart Failure Diagnoses in Hospitalized Patients With the Nationwide Claim-Based JROAD-DPC Database. Circ Rep 2021; 3:131-136. [PMID: 33738345 PMCID: PMC7956876 DOI: 10.1253/circrep.cr-21-0004] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background:
Big data systems such as diagnosis procedure combination (DPC) datasets have recently been used for research purposes. However, there have been few validation studies to determine the accuracy of diagnoses. The aim of this study was to validate and evaluate 2 diagnoses, namely acute myocardial infarction (AMI) and heart failure (HF), using International Classification of Diseases, 10th revision (ICD-10) codes in the Japanese Registry Of All cardiac and vascular Disease (JROAD)-DPC database. Methods and Results:
ICD-10 codes I21.0–I21.9 and I50.0–I50.9 were used to identify AMI and HF, respectively, in the JROAD-DPC database. Diagnoses of AMI and HF were validated in clinical datasets assessing sensitivity and positive predictive value (PPV). Over 1–2 years, 742 patients hospitalized for AMI and 1,368 patients hospitalized for HF were identified in the DPC dataset. Sensitivity and PPV for AMI were 78.9% and 78.8%, respectively. When emergency hospitalization was included as a criterion, PPV increased to 84.9%. For HF, sensitivity and PPV were 84.7% and 57.0%, respectively. When emergency hospitalization and acute HF were included as criteria, PPV increased to 83.0%. Conclusions:
Using ICD-10 codes for AMI and HF diagnoses among hospitalized patients, the DPC dataset showed acceptable concordance with clinical datasets. PPV increased when any conditions of hospitalization were included, especially in HF.
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Affiliation(s)
| | | | - Yoko Sumita
- National Cerebral and Cardiovascular Center Suita Japan
| | - Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital Nobeoka Japan
| | - Keiji Uchida
- Division of Cardiology, Yokohama City University Medical Center Yokohama Japan
| | - Nobutaka Nagano
- Division of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University Hospital Sapporo Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health Kyoto Japan
| | | | - Kazufumi Tsuchihashi
- Division of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University Hospital Sapporo Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center Yokohama Japan
| | - Yoshihiro Saito
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University Kumamoto Japan
| | - Hisao Ogawa
- National Cerebral and Cardiovascular Center Suita Japan
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Hospital, Tohoku University Graduate School of Medicine Sendai Japan
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49
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Kanaoka K, Okayama S, Terasaki S, Nakano T, Ishii M, Nakai M, Onoue K, Nishimura K, Yasuda S, Tsujita K, Kawakami R, Miyamoto Y, Tsutsui H, Komuro I, Ogawa H, Saito Y. Role of climatic factors in the incidence of Takotsubo syndrome: A nationwide study from 2012 to 2016. ESC Heart Fail 2020; 7:2629-2636. [PMID: 32715646 PMCID: PMC7524088 DOI: 10.1002/ehf2.12843] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 05/01/2020] [Accepted: 05/29/2020] [Indexed: 11/15/2022] Open
Abstract
Aims This study aimed to investigate the influence of climatic factors on the onset of Takotsubo syndrome (TTS). Methods and results We performed a retrospective nationwide study among patients registered in the Japanese Registry of All Cardiac and Vascular Diseases and Diagnosis Procedure Combination (JROAD–DPC) discharge database, between 2012 and 2016. Before the analysis, a multicentre validation study was conducted for assessing the accuracy of the JROAD–DPC classification for TTS. First, we investigated the seasonal variation of incidences of TTS. Second, we analysed the associations between the incidence of TTS and climatic factors using the hierarchical Poisson regression modelling, and we also investigated the associations between typhoon landfalls and hospitalization for TTS, using the fixed‐effects conditional Poisson regression model. The sensitivity and specificity for diagnosis were 83% and 100%, respectively. Then we analysed 5643 patients with TTS. The mean patient age was 74 (standard deviation ± 11) years; 79% were female. TTS was diagnosed significantly more frequently in the summer and early autumn. The incidence of TTS was related to higher temperatures; adjusted incidence rate ratios were 1.46 [95% confidence interval (CI): 1.33–1.60, P < 0.01] and 1.47 (95% CI: 1.34–1.62, P < 0.01) for temperatures of 20–25°C and >25°C, respectively. The incidence rate ratio for the first 2 days after a typhoon landfall was 1.85 (95% CI: 1.07–3.19; P = 0.03). Conclusions This study demonstrates distinct patterns of seasonal variation in the incidence of TTS, as well as a significant association between its onset and climatic factors, including typhoon landfalls.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, Japan
| | - Satoshi Okayama
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, Japan
| | - Satoshi Terasaki
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, Japan
| | - Tomoya Nakano
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, Japan
| | | | - Satoshi Yasuda
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, Japan
| | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hisao Ogawa
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, Japan
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50
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Ishii M, Seki T, Kaikita K, Sakamoto K, Nakai M, Sumita Y, Nishimura K, Miyamoto Y, Noguchi T, Yasuda S, Kanaoka K, Terasaki S, Saito Y, Tsutsui H, Komuro I, Ogawa H, Tsujita K, Kawakami K. Association of short-term exposure to air pollution with myocardial infarction with and without obstructive coronary artery disease. Eur J Prev Cardiol 2020; 28:1435-1444. [PMID: 34695220 DOI: 10.1177/2047487320904641] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 10/09/2019] [Indexed: 11/16/2022]
Abstract
Background Air pollution including particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5) increases the risk of acute myocardial infarction. However, whether short-term exposure to PM2.5 triggers the onset of myocardial infarction with nonobstructive coronary arteries, compared with myocardial infarction with coronary artery disease, has not been elucidated. This study aimed to estimate the association between short-term exposure to PM2.5 and admission for acute myocardial infarction, myocardial infarction with coronary artery disease, and myocardial infarction with nonobstructive coronary arteries. Design This was a time-stratified case-crossover study and multicenter validation study. Methods This study used a nationwide administrative database in Japan between April 2012–March 2016. Of 137,678 acute myocardial infarction cases, 123,633 myocardial infarction with coronary artery disease and 14,045 myocardial infarction with nonobstructive coronary arteries were identified by a validated algorithm combined with International Classification of Disease (10th revision), diagnostic, and procedure codes. Air pollutants and meteorological data were obtained from the monitoring station nearest to the admitting hospital. Results In spring (March–May), the short-term increase of 10 µg/m3 in PM2.5 2 days before admission was significantly associated with admission for acute myocardial infarction, myocardial infarction with nonobstructive coronary arteries, and myocardial infarction with coronary artery disease after adjustment for meteorological variables (odds ratio 1.060, 95% confidence interval 1.038–1.082; odds ratio 1.151, 1.079–1.227; odds ratio 1.049, 1.026–1.073, respectively), while the association was not significant in other variables. These associations were also observed after adjustment for other co-pollutants. The risk for myocardial infarction with nonobstructive coronary arteries (vs myocardial infarction with coronary artery disease) was associated with an even lower concentration of PM2.5 under the current environmental standards. Conclusions This study showed the seasonal difference of acute myocardial infarction risk attributable to PM2.5 and the difference in the threshold of triggering the onset of acute myocardial infarction subtype.
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Affiliation(s)
- Masanobu Ishii
- Graduate School of Medical Sciences, Kumamoto University, Japan
- Graduate School of Medicine and Public Health, Kyoto University, Japan
- National Cerebral and Cardiovascular Center, Japan
| | - Tomotsugu Seki
- Graduate School of Medicine and Public Health, Kyoto University, Japan
| | - Koichi Kaikita
- Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Kenji Sakamoto
- Graduate School of Medical Sciences, Kumamoto University, Japan
| | | | - Yoko Sumita
- National Cerebral and Cardiovascular Center, Japan
| | | | | | | | | | | | | | | | | | - Issei Komuro
- Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Japan
| | - Hisao Ogawa
- National Cerebral and Cardiovascular Center, Japan
| | - Kenichi Tsujita
- Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Koji Kawakami
- Graduate School of Medicine and Public Health, Kyoto University, Japan
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