What is the clinical evidence from this study?

Study design: Cohort. Population: Congestive Heart Failure (n=3578). Intervention: Advanced age (>70 years) vs. Age ≤70 years. Primary outcome: Death from all causes (HR 1.71, 95% CI 1.38-2.12, p=<0.001).

January 1, 2008Open Access

Clinical Characteristics and Outcome of Hospitalized Patients With Congestive Heart Failure

Q: What are the key findings of this study?

In Japanese patients hospitalized for heart failure, the 1- and 3-year mortality rates were 11.3% and 29.2%, with advanced age (HR 1.71) significantly predicting all-cause death.

Key Result

In Japanese patients hospitalized for heart failure, the 1- and 3-year mortality rates were 11.3% and 29.2%, with advanced age (HR 1.71) significantly predicting all-cause death.

Study Design

Type

Cohort (n=3,578)

Multicenter

Yes

Structured PICO

Population

3,578 Japanese patients (mean age 69.8 years, 40.7% female) hospitalized for congestive heart failure, followed for a median of 2.8 years.

Outcome

Death from all causeshard clinical

Japanese patients hospitalized for heart failure demonstrate a lower long-term mortality rate compared to Western populations, though several modifiable risk factors such as anemia and renal impairment remain significant predictors of death.

Main Result

Hazard Ratio: 1.71 (95% CI 1.38–2.12)

p-value: p=<0.001

Limitations

Retrospective cohort design
Incidence of heart failure might have been underestimated due to the insensitivity of the Framingham criteria towards early manifestations
Management decisions were left to the discretion of each physician
Cause of death occasionally could not be determined
Glomerular filtration rate was not determined as a prognostic factor

Abstract

BACKGROUND: Heart failure (HF) represents a major public health issue in an aging population. Although HF is a leading cause of morbidity and mortality in developed countries, the clinical features of HF in Japan remain unclear. METHODS AND RESULTS: This observational cohort study analyzed data from the Heart Institute of Japan--Department of Cardiology (HIJC)-HF Registry, which is based on a nationwide survey by the HIJC, Tokyo Women's Medical University and its affiliated hospitals. Of 3,578 consecutive patients (average age, 69.8 years; females 40.7%) hospitalized for HF between January 2001 and December 2002, 95.0% were followed up until the end of 2005 (median, 2.8 years). The 1- and 3-year mortality rates were 11.3% and 29.2%, respectively. Multivariate analysis revealed that advanced age (hazard ratio 1.71 95% confidence interval 1.38-2.12; p<0.001), symptomatic HF at hospital discharge (3.76 2.30-6.17; p<0.001), renal impairment (1.96 1.50-2.57; p=0.008), anemia (1.46 1.18-1.80; p=0.02) and low pulse pressure (2.88 1.62-5.13; p=0.0003) were significantly associated with total death. CONCLUSION: Although the long-term mortality rate for Japanese patients with HF is lower than in other countries, several markers are modifiable. The data demonstrate that continued improvements in the treatment of Japanese patients with HF are still needed.

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