What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure (n=13238). Intervention: Acute decompensated heart failure. Primary outcome: All-cause death during hospitalization and all-cause death during the follow-up period.

April 14, 2021Circulation Journal170 citationsOpen Access

Clinical Characteristics and Outcomes of Hospitalized Patients With Heart Failure From the Large-Scale Japanese Registry Of Acute Decompensated Heart Failure (JROADHF)

TITomomi Ide HKHidetaka Kaku SMShouji Matsushima

Key Result

A contemporary nationwide registry of 13,238 hospitalized heart failure patients in Japan demonstrated an in-hospital mortality rate of 7.7% and an all-cause death incidence of 14.9 per 100 person-years during follow-up, highlighting a very elderly population with poor prognosis.

Study Design

Type

Observational (n=13,238)

Multicenter

Yes

Structured PICO

Population

13,238 hospitalized patients with heart failure in Japan, with a mean age of 78 years and 45.1% having preserved ejection fraction, followed for a median of 4.3 years.

Outcome

In-hospital mortality, cardiovascular death, and rehospitalization for HFhard clinical

A large-scale Japanese registry highlights that hospitalized heart failure patients are increasingly elderly, frequently have HFpEF, and face high rates of mortality and rehospitalization.

Limitations

Retrospective study limited to existing medical information and procedures.
Could not enroll all patients screened by cluster random sampling because 65 facilities did not participate.
Included only JCS-certified hospitals and excluded hospitals with fewer than 11 HF admissions, limiting generalization.
Data were collected from 2013, which is not very recent.
Subgroup analysis data according to LVEF categories were not available.
Hospital factors such as case volume and access to medical care were not included in the analysis.

Abstract

BACKGROUND: With aging population, the prevalence and incidence of heart failure (HF) have been increasing worldwide. However, the characteristics and outcomes of patients with HF in an era of aging are not well established in Japan. METHODS AND RESULTS: The Japanese Registry Of Acute Decompensated Heart Failure (JROADHF), a retrospective, multicenter, nationwide registry, was designed to study the clinical characteristics and outcomes of patients hospitalized with HF throughout Japan in 2013. One hundred and twenty-eight hospitals were selected by cluster random sampling and 13,238 hospitalized patients with HF were identified by medical record review. Demographics, medical history, severity, treatment, and in-hospital and long-term outcome data were collected from the Diagnostic Procedure Combination and medical charts. Data were analyzed using univariate and multivariate logistic regression or Cox regression analysis. The mean age of registered patients was 78.0±12.5 years and 52.8% were male. Elderly patients (age >75 years) accounted for 68.9%, and HF with preserved ejection fraction (HFpEF) accounted for 45.1%. Median length of hospital stay was 18 days and in-hospital mortality was 7.7%. The median follow-up period was 4.3 years, and the incidence rates for cardiovascular death and rehospitalization for HF were 7.1 and 21.1 per 100 person-years, respectively. CONCLUSIONS: A contemporary nationwide registry demonstrated that hospitalized HF patients were very elderly, HFpEF was common, and their prognosis was still poor in Japan.

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