著者

Tomomi Ide Hidetaka Kaku Shouji Matsushima Takeshi Tohyama Nobuyuki Enzan Kouta Funakoshi Yoko Sumita Michikazu Nakai Kunihiro Nishimura Yoshihiro Miyamoto Miyuki Tsuchihashi-Makaya Masaru Hatano Issei Komuro Hiroyuki Tsutsui the JROADHF Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-0947, (Released:2021-04-15)

参考文献数

35

被引用文献数

56

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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 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.

著者

Misa Takegami Yoshihiro Miyamoto Satoshi Yasuda Michikazu Nakai Kunihiro Nishimura Hisao Ogawa Ken-ichi Hirata Ryuji Toh Yoshihiro Morino Motoyuki Nakamura Yasuchika Takeishi Hiroaki Shimokawa Hiroaki Naito

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.79, no.5, pp.1000-1008, 2015-04-24 (Released:2015-04-24)

参考文献数

27

被引用文献数

1 23

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Background:Large earthquakes have been associated with cardiovascular disease (CVD) mortality. In Japan, the 1995 Great Hanshin-Awaji (H-A) Earthquake was an urban-underground-type earthquake, whereas the 2011 Great East Japan (GEJ) Earthquake was an ocean-trench type. In the present study, we examined how these different earthquake types affected CVD mortality.Methods and Results:We examined death certificate data from 2008 to 2012 for 131 municipalities in Iwate, Miyagi, and Fukushima prefectures (n=320,348) and from 1992 to 1996 for 220 municipalities in Hyogo, Osaka, and Kyoto prefectures (n=592,670). A Poisson regression model showed significant increases in the monthly numbers of acute myocardial infarction (AMI)-related deaths (incident rate ratio [IRR] GEJ=1.34, P=0.001; IRR of H-A=1.57, P<0.001) and stroke-related deaths (IRR of GEJ=1.42, P<0.001; IRR of H-A=1.33, P<0.001) after the earthquakes. Two months after the earthquakes, AMI deaths remained significant only for H-A (IRR=1.13, P=0.029). When analyzing the standardized mortality ratio (SMR) after the earthquakes using the Cochran-Armitage trend test, seismic intensity was significantly associated with AMI mortality for 2 weeks after both the GEJ (P for trend=0.089) and H-A earthquakes (P for trend=0.005).Conclusions:Following the GEJ and H-A earthquakes, there was a sharp increase in CVD mortality. The effect of the disaster was sustained for months after the H-A earthquake, but was diminished after the GEJ Earthquake. (Circ J 2015; 79: 1000–1008)

著者

Taishi Okuno Jiro Aoki Kengo Tanabe Koichi Nakao Yukio Ozaki Kazuo Kimura Junya Ako Teruo Noguchi Satoshi Yasuda Satoru Suwa Kazuteru Fujimoto Yasuharu Nakama Takashi Morita Wataru Shimizu Yoshihiko Saito Atsushi Hirohata Yasuhiro Morita Teruo Inoue Atsunori Okamura Toshiaki Mano Kazuhito Hirata Yoshisato Shibata Mafumi Owa Kenichi Tsujita Hiroshi Funayama Nobuaki Kokubu Ken Kozuma Shiro Uemura Tetsuya Tobaru Keijiro Saku Shigeru Ohshima Kunihiro Nishimura Yoshihiro Miyamoto Hisao Ogawa Masaharu Ishihara on behalf of J-MINUET investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-18-0995, (Released:2019-03-30)

参考文献数

40

被引用文献数

6

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Background: Beta-blockers are standard therapy for acute myocardial infarction (AMI). However, despite current advances in the management of AMI, it remains unclear whether all AMI patients benefit from β-blockers. We investigated whether admission heart rate (HR) is a determinant of the effectiveness of β-blockers for AMI patients. Methods and Results: We enrolled 3,283 consecutive AMI patients who were admitted to 28 participating institutions in the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) study. According to admission HR, we divided patients into 3 groups: bradycardia (HR <60 beats/min, n=444), normocardia (HR 60 to ≤100 beats/min, n=2,013), and tachycardia (HR >100 beats/min, n=342). The primary endpoint was major adverse cardiac events (MACE), including all-cause death, non-fatal MI, non-fatal stroke, heart failure (HF), and urgent revascularization for unstable angina, at 3-year follow-up. Beta-blocker at discharge was significantly associated with a lower risk of MACE in the tachycardia group (23.6% vs. 33.0%; P=0.033), but it did not affect rates of MACE in the normocardia group (17.8% vs. 18.4%; P=0.681). In the bradycardia group, β-blocker use at discharge was significantly associated with a higher risk of MACE (21.6% vs. 12.7%; P=0.026). Results were consistent for multivariable regression and stepwise multivariable regression. Conclusions: Admission HR might determine the efficacy of β-blockers for current AMI patients.

著者

Shunsuke Murata Misa Takegami Daisuke Onozuka Yuriko Nakaoku Akihito Hagihara Kunihiro Nishimura

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20200113, (Released:2020-06-27)

参考文献数

19

被引用文献数

5

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Background. Dementia-related missing and subsequent deaths are becoming serious problems with increases in people with dementia. However, there are no sufficient studies investigating the incidence rate, the mortality rate, and their risk factors.Methods. An ecological study aggregated at the Japanese prefectural level was conducted. Dementia-related missing persons cases and deaths in 2018 were extracted from the statistics of the National Police Agency in Japan. We extracted variables about older adults’ characteristics, care, and safety as candidate variables considered to be relevant to dementia-related missing persons cases and deaths. Associations of the candidate variables with the incidence and mortality rates were analyzed using the generalized linear model (family: quasi-poisson, link: log) adjusted for confounding factors (proportion of older adults and gross prefectural product).Results. The incidence rate and mortality rate per 100,000 person-year was 21.72 and 0.652 in Japan, respectively. One facility increase in the number of nursing care facilities for older adults per 100,000 persons aged 65-years-old or more was associated with a 7.9% (95% confidence interval, 3.3–12.4) decrease in the incidence rate. One increase in the number of public health nurses per 100,000 persons was associated with a 3.2% (1.6–4.9) decrease in the incidence rate. A ten percent increase in the proportion of people who live in an urban area was associated with a 20.3% (8.7–33.2) increase in the incidence rate and a 12.9% (5.6–19.8) decrease in the mortality rate.Conclusions. Identified associated factors may be useful for managing or predicting dementia-related missing persons cases and associated deaths.

著者

Hiroki Nakano Kazunori Omote Toshiyuki Nagai Michikazu Nakai Kunihiro Nishimura Yasuyuki Honda Satoshi Honda Naotsugu Iwakami Yasuo Sugano Yasuhide Asaumi Takeshi Aiba Teruo Noguchi Kengo Kusano Hiroyuki Yokoyama Satoshi Yasuda Hisao Ogawa Taishiro Chikamori Toshihisa Anzai on behalf of the NaDEF Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.83, no.3, pp.614-621, 2019-02-25 (Released:2019-02-25)

参考文献数

36

被引用文献数

2 6

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Background: The ideal mortality prediction model (MPM) for acute heart failure (AHF) patients would have sufficient and stable predictive ability for long-term as well as short-term mortality. However, published MPMs for AHF predominantly predict short-term mortality up to 90 days, and their prognostic performance for long-term mortality remains unclear. Methods and Results: We analyzed 609 AHF patients in a prospective registry from January 2013 to May 2016. We compared the prognostic performance for long-term mortality among 8 systematically identified MPMs for AHF that predict short-term mortality up to 90 days from admission. The PROTECT 7-day model showed the highest c-index for long-term as well as short-term mortality among the studied MPMs. Sensitivity analyses revealed serum albumin and total cholesterol to be the most important variables, as dropping these variables resulted in a significant decline in c-index, when compared with other variables specific to the PROTECT 7-day model. Furthermore, significant improvements in c-index and net reclassification were observed when serum albumin or serum albumin plus total cholesterol was added to the studied MPMs, other than the PROTECT 7-day model. Conclusions: The PROTECT 7-day model demonstrated the highest predictive performance for long-term as well as short-term mortality in AHF patients among the published MPMs. Our findings indicate the importance of accounting for nutritional status such as serum albumin and total cholesterol in AHF patients when developing a MPM.

著者

Michikazu Nakai Makoto Watanabe Yoshihiro Kokubo Kunihiro Nishimura Aya Higashiyama Misa Takegami Yoko M Nakao Tomonori Okamura Yoshihiro Miyamoto

出版者

Japan Atherosclerosis Society

雑誌

Journal of Atherosclerosis and Thrombosis (ISSN:13403478)

巻号頁・発行日

pp.48843, (Released:2020-02-06)

参考文献数

41

被引用文献数

29

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Aim: To construct a risk prediction model for cardiovascular disease (CVD) based on the Suita study, an urban Japanese cohort study, and compare its accuracy against the Framingham CVD risk score (FRS) model. Methods: After excluding participants with missing data or those who lost to follow-up, this study consisted of 3,080 men and 3,470 women participants aged 30–79 years without CVD at baseline in 1989–1999. The main outcome of this study was incidence of CVD, defined as the incidence of stroke or coronary heart disease. Multivariable Cox proportional hazards models with stepwise selection were used to develop the prediction model. To assess model performance, concordance statistics (C-statistics) and their 95% confidence intervals (CIs) were calculated using a bootstrap procedure. A calibration test was also conducted. Results: During a median follow-up period of 16.9 years, 351 men and 241 women developed CVD. We formulated risk models with and without electrocardiogram (ECG) data that included age, sex, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, diabetes mellitus, smoking, and urinary protein as risk factors. The C-statistics of the Suita CVD risk models with ECG data (0.782; 95% CI, 0.766–0.799) and without ECG data (0.781; 95% CI, 0.765–0.797) were significantly higher than that of the FRS model (0.768; 95% CI, 0.750–0.785). Conclusions: The Suita CVD risk model is feasible to use and improves predictability of the incidence of CVD relative to the FRS model in Japan.

著者

Kunihiro Nishimura Tomonori Okamura Makoto Watanabe Michikazu Nakai Misa Takegami Aya Higashiyama Yoshihiro Kokubo Akira Okayama Yoshihiro Miyamoto

出版者

Japan Atherosclerosis Society

雑誌

Journal of Atherosclerosis and Thrombosis (ISSN:13403478)

巻号頁・発行日

vol.21, no.8, pp.784-798, 2014-08-26 (Released:2014-08-26)

参考文献数

57

被引用文献数

132 146

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Aim: The Framingham risk score (FRS) is one of the standard tools used to predict the incidence of coronary heart disease (CHD). No previous study has investigated its efficacy for a Japanese population cohort. The purpose of this study was to develop new coronary prediction algorithms for the Japanese population in the manner of the FRS, and to compare them with the original FRS. Methods: Our coronary prediction algorithms for Japanese were based on a large population-based cohort study (Suita study). The study population comprised 5,521 healthy Japanese. They were followed-up for 11.8 years on average, and 213 cases of CHD were observed. Multiple Cox proportional hazard model by stepwise selection was used to construct the prediction model. Results: Our coronary prediction algorithms for Japanese patients were based on a large populationbased cohort study (the Suita study). A multiple Cox proportional hazard model by stepwise selection was used to construct the prediction model. The C-statistics showed that the new model had better accuracy than the original and recalibrated Framingham scores. The net reclassification improvement (NRI) by the Suita score with the inclusion of CKD was 41.2% (P<0.001) compared with the original FRS. The recalibration of the FRS slightly improved the efficiency of the prediction, but it was still worse than the Suita score with the CKD model. The calibration analysis suggested that the original FRS and the recalibrated FRS overestimated the risk of CHD in the Japanese population. The Suita score with CKD more accurately predicted the risk of CHD. Conclusion: The FRS and recalibrated FRS overestimated the 10-year risk of CHD for the Japanese population. A predictive score including CKD as a coronary risk factor for the Japanese population was more accurate for predicting CHD than the original Framingham risk scores in terms of the C-statics and NRI.

著者

Yasushi Matsuzawa Masaaki Konishi Michikazu Nakai Yusuke Saigusa Masataka Taguri Masaomi Gohbara Toshiaki Ebina Masami Kosuge Kiyoshi Hibi Kunihiro Nishimura Yoshihiro Miyamoto Satoshi Yasuda Hisao Ogawa Yoshihiko Saito Naoki Nakayama Ichiro Takeuchi Kouichi Tamura Kazuo Kimura

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.84, no.7, pp.1140-1146, 2020-06-25 (Released:2020-06-25)

参考文献数

16

被引用文献数

16 15

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Background:Low population density may be associated with high mortality in acute myocardial infarction (AMI) patients. The purpose of this study was to investigate the effect of population density and hospital primary percutaneous coronary intervention (PCI) volume on AMI in-hospital mortality in Japan.Methods and Results:This is a retrospective study of 64,414 AMI patients transported to hospital by ambulances. The main outcome measure was in-hospital mortality. The median population density was 1,147 (interquartile range, 342–5,210) persons/km2. There was a significant negative relationship between population density and in-hospital mortality (OR for a quartile down in population density 1.086, 95% CI 1.042–1.132, P<0.001). Patients in less densely populated areas were more often transported to hospitals with a lower primary PCI volume, and they had a longer distance to travel. By using multivariable analysis, primary PCI volume was found to be significantly associated with in-hospital mortality, but distance to hospital was not. When divided into the low- and high-volume hospitals, using the cut-off value of 115 annual primary PCI procedures, the increase in in-hospital mortality associated with low population density was observed only in patients hospitalized in the low-volume hospitals.Conclusions:Increased in-hospital mortality related to low population density was observed only in AMI patients who were transported to the low primary PCI volume hospitals, but not in those who were transported to high-volume hospitals.

著者

Kunihiro Nishimura Kuniaki Ogasawara Takanari Kitazono Koji Iihara on behalf of the J-ASPECT Study Collaborators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-1214, (Released:2021-08-13)

参考文献数

27

被引用文献数

1

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Background:The degree of association between mortality and case volume/physician volume is well known for many surgical procedures and medical conditions. However, the link between physician volume and death rate in patients hospitalized for stroke remains unclear. This study analyzed the correlation between in-hospital stroke mortality and physician volume per hospital, considering board certification status.Methods and Results:For this retrospective registry-based cohort study, data were obtained from the Japanese nationwide registry on patients hospitalized for ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) between 2010 and 2016. The number of stroke care physicians and relevant board-certified physicians was also obtained. Odd ratios (ORs) of 30-day in-hospital mortality were estimated after adjusting for institutional and patient differences using generalized mixed logistic regression. From 295,150 (ischemic stroke), 98,657 (ICH), and 36,174 (SAH) patients, 30-day in-hospital mortality rates were 4.4%, 16.0%, and 26.6%, respectively. There was a correlation between case volume and physician volume. A higher number of stroke care physicians was associated with a reduction in 30-day mortality after adjusting for stroke case volume and comorbidities for all stroke types (all P for trend<0.05).Conclusions:An increased number of stroke care physicians was associated with reduced in-hospital mortality for all types of stroke. The volume threshold of board-certified physicians depends on the specialty and stroke type.

著者

Yousuke Hashimoto Yukio Ozaki Shino Kan Koichi Nakao Kazuo Kimura Junya Ako Teruo Noguchi Satoru Suwa Kazuteru Fujimoto Kazuoki Dai Takashi Morita Wataru Shimizu Yoshihiko Saito Atsushi Hirohata Yasuhiro Morita Teruo Inoue Atsunori Okamura Toshiaki Mano Minoru Wake Kengo Tanabe Yoshisato Shibata Mafumi Owa Kenichi Tsujita Hiroshi Funayama Nobuaki Kokubu Ken Kozuma Shiro Uemura Tetsuya Tobaru Keijiro Saku Shigeru Oshima Satoshi Yasuda Tevfik F Ismail Takashi Muramatsu Hideo Izawa Hiroshi Takahashi Kunihiro Nishimura Yoshihiko Miyamoto Hisao Ogawa Masaharu Ishihara on behalf of J-MINUET Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-1115, (Released:2021-06-03)

参考文献数

31

被引用文献数

18

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Background:The impact of chronic kidney disease (CKD) on long-term outcomes following acute myocardial infarction (AMI) in the era of modern primary PCI with optimal medical therapy is still in debate.Methods and Results:A total of 3,281 patients with AMI were enrolled in the J-MINUET registry, with primary PCI of 93.1% in STEMI. CKD stage on admission was classified into: no CKD (eGFR ≥60 mL/min/1.73 m2); moderate CKD (60>eGFR≥30 mL/min/1.73 m2); and severe CKD (eGFR <30 mL/min/1.73 m2). While the primary endpoint was all-cause mortality, the secondary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, cardiac failure, myocardial infarction (MI) and stroke. Of the 3,281 patients, 1,878 had no CKD, 1,073 had moderate CKD and 330 had severe CKD. Pre-person-days age- and sex-adjusted in-hospital mortality significantly increased from 0.014% in no CKD through 0.042% in moderate CKD to 0.084% in severe CKD (P<0.0001). Three-year mortality and MACE significantly deteriorated from 5.09% and 15.8% in no CKD through 16.3% and 38.2% in moderate CKD to 36.7% and 57.9% in severe CKD, respectively (P<0.0001). C-index significantly increased from the basic model of 0.815 (0.788–0.841) to 0.831 (0.806–0.857), as well as 0.731 (0.708–0.755) to 0.740 (0.717–0.764) when adding CKD stage to the basic model in predicting 3-year mortality (P=0.013; net reclassification improvement [NRI] 0.486, P<0.0001) and MACE (P=0.046; NRI 0.331, P<0.0001) respectively.Conclusions:CKD remains a useful predictor of in-hospital and 3-year mortality as well as MACE after AMI in the modern PCI and optimal medical therapy era.

著者

Yoshiaki Ohyama Norimichi Koitabashi Tetsuya Nakamura Yoko Sumita Michikazu Nakai Kunihiro Nishimura Yoshihiro Miyamoto Masahiko Kurabayashi

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.1, no.7, pp.296-302, 2019-07-10 (Released:2019-07-10)

参考文献数

23

被引用文献数

1

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Background:Previous randomized clinical studies have raised concerns about whether inferior vena cava filter (IVCF) can benefit patients with venous thromboembolism (VTE). The present study therefore investigated whether IVCF are associated with in-hospital mortality in Japan.Methods and Results:This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). Of 2,368,165 patients included in JROAD-DPC, we identified 28,238 who were hospitalized with VTE between 2012 and 2014. We compared in-hospital mortality rates between patients with or without IVCF using propensity score (PS) matching. PS were estimated using logistic regression models in which IVCF was the dependent variable. The other variables consisted of age, sex, Charlson comorbidity index, anti-thrombotic agents and clinical disease status. Patients were aged 68±16 years, and 59.7% were female. Of 28,238 patients, 6,937 (24.5%) were treated with an IVCF. The overall in-hospital mortality was 4.3%. On PS-matched analysis in-hospital mortality was significantly lower with, than without, IVCF (3.1% vs. 4.4%, P<0.001; OR, 0.65; 95% CI: 0.54–0.79).Conclusions:Having an IVCF was independently associated with lower in-hospital mortality in Japanese patients with VTE. This is in sharp contrast to the benefits of IVCF in other countries. The reasons for this difference require further investigation.

著者

Masaharu Ishihara Koichi Nakao Yukio Ozaki Kazuo Kimura Junya Ako Teruo Noguchi Masashi Fujino Satoshi Yasuda Satoru Suwa Kazuteru Fujimoto Yasuharu Nakama Takashi Morita Wataru Shimizu Yoshihiko Saito Atsushi Hirohata Yasuhiro Morita Teruo Inoue Atsunori Okamura Masaaki Uematsu Kazuhito Hirata Kengo Tanabe Yoshisato Shibata Mafumi Owa Kenichi Tsujita Hiroshi Funayama Nobuaki Kokubu Ken Kozuma Tetsuya Tobaru Shigeru Oshima Michikazu Nakai Kunihiro Nishimura Yoshihiro Miyamoto Hisao Ogawa on behalf of J-MINUET Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.81, no.7, pp.958-965, 2017-06-23 (Released:2017-06-23)

参考文献数

24

被引用文献数

34 41

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Background:According to troponin-based criteria of myocardial infarction (MI), patients without elevation of creatine kinase (CK), formerly classified as unstable angina (UA), are now diagnosed as non-ST-elevation MI (NSTEMI), but little is known about their outcomes.Methods and Results:Between July 2012 and March 2014, 3,283 consecutive patients with MI were enrolled. Clinical follow-up data were obtained up to 3 years. The primary endpoint was a composite of all-cause death, non-fatal MI, non-fatal stroke, cardiac failure and urgent revascularization for UA. There were 2,262 patients with ST-elevation MI (STEMI), 563 NSTEMI with CK elevation (NSTEMI+CK) and 458 NSTEMI without CK elevation (NSTEMI-CK). From day 0, Kaplan-Meier curves for the primary endpoint began to diverge in favor of NSTEMI-CK for up to 30 days. The 30-day event rate was significantly lower in patients with NSTEMI-CK (3.3%) than in STEMI (8.6%, P<0.001) and NSTEMI+CK (9.9%, P<0.001). Later, the event curves diverged in favor of STEMI. The event rate from 31 days to 3 years was significantly lower in patients with STEMI (19.8%) than in NSTEMI+CK (33.6%, P<0.001) and NSTEMI-CK (34.2%, P<0.001). Kaplan-Meier curves from 31 days to 3 years were almost identical between NSTEMI+CK and NSTEMI-CK (P=0.91).Conclusions:Despite smaller infarct size and better short-term outcomes, long-term outcomes of NSTEMI-CK after convalescence were as poor as those for NSTEMI+CK and worse than for STEMI.

著者

Koshiro Kanaoka Satoshi Okayama Michikazu Nakai Yoko Sumita Kunihiro Nishimura Rika Kawakami Hiroyuki Okura Yoshihiro Miyamoto Satoshi Yasuda Hiroyuki Tsutsui Issei Komuro Hisao Ogawa Yoshihiko Saito

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.83, no.5, pp.1025-1031, 2019-04-25 (Released:2019-04-25)

参考文献数

21

被引用文献数

31 46

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Background: With aging of the population, the economic burden associated with heart failure (HF) is expected to increase. However, little is known about the hospitalization costs associated with HF in Japan. Methods and Results: In this cross-sectional study, using data from The Japanese Registry of All Cardiac and Vascular Diseases (JROAD) and JROAD-Diagnosis Procedure Combination databases between 2012 and 2014, we evaluated hospitalization costs for acute cardiovascular diseases (CVDs), including HF. A total of &#36;1,187 million/year (44% of the hospitalization costs for acute CVDs) was spent on patients with HF. We identified 273,865 patients with HF and the median cost per patient was &#36;8,089 (&#36;5,362–12,787) per episode. The top 1% of spenders accounted for 8% (&#36;80 million/year), and the top 5% of spenders accounted for 22% (&#36;229 million/year) of the entire cost associated with HF. The costs associated with HF for patients over 75 years of age accounted for 68% of the total cost. Conclusions: The costs associated with HF were higher than the hospitalization cost for any other acute CVD in Japan. Understanding how the total hospitalization cost is distributed may allow health providers to utilize limited resources more effectively for patients with HF.

著者

Michikazu Nakai Yoshitaka Iwanaga Yoko Sumita Koshiro Kanaoka Rika Kawakami Masanobu Ishii Keiji Uchida Nobutaka Nagano Takeo Nakayama Kunihiro Nishimura Kazufumi Tsuchihashi Kazuo Kimura Yoshihiro Saito Kenichi Tsujita Hisao Ogawa Yoshihiro Miyamoto Satoshi Yasuda on the behalf of the JROAD Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.3, no.3, pp.131-136, 2021-03-10 (Released:2021-03-10)

参考文献数

25

被引用文献数

12 35

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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.

著者

Makoto Miyake Misa Takegami Yuki Obayashi Masashi Amano Takeshi Kitai Tomoyuki Fujita Tadaaki Koyama Hidekazu Tanaka Kenji Ando Tatsuhiko Komiya Masaki Izumo Hiroya Kawai Kiyoyuki Eishi Kiyoshi Yoshida Takeshi Kimura Ryuzo Nawada Tomohiro Sakamoto Yoshisato Shibata Toshihiro Fukui Kenji Minatoya Kenichi Tsujita Yasushi Sakata Tetsuya Kimura Kumiko Sugio Atsushi Takita Atsushi Iwakura Toshihiro Tamura Kunihiro Nishimura Yutaka Furukawa Chisato Izumi for the BPV-AF Registry Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-22-0226, (Released:2022-07-08)

参考文献数

28

被引用文献数

2

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Background: Current guidelines equally recommend direct oral anticoagulants (DOACs) and warfarin for atrial fibrillation (AF) patients with a bioprosthetic valve (BPV); however, there are limited data comparing DOACs and warfarin in AF patients with an aortic BPV.Methods and Results: This post-hoc subgroup analysis of a multicenter, prospective, observational registry (BPV-AF Registry) aimed to compare DOACs and warfarin in AF patients with an aortic BPV. The primary outcome was a composite of stroke, systemic embolism, major bleeding, heart failure requiring hospitalization, all-cause death, or BPV reoperation. The analysis included 479 patients (warfarin group, n=258; DOAC group, n=221). Surgical aortic valve replacement was performed in 74.4% and 36.7% of patients in the warfarin and DOAC groups, respectively. During a mean follow up of 15.5 months, the primary outcome occurred in 45 (17.4%) and 32 (14.5%) patients in the warfarin and DOAC groups, respectively. No significant difference was found in the primary outcome between the 2 groups (adjusted hazard ratio: 0.88, 95% confidence interval: 0.51–1.50). No significant multiplicative interaction was observed between the anticoagulant effects and type of aortic valve procedure (P=0.577).Conclusions: Among AF patients with an aortic BPV, no significant difference was observed in the composite outcome of adverse clinical events between patients treated with warfarin and those treated with DOACs, suggesting that DOACs can be used as alternatives to warfarin in these patients.

著者

Naotsugu Iwakami Toshiyuki Nagai Toshiaki A. Furukawa Kunihiro Nishimura Toshihisa Anzai

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.2, no.1, pp.10-16, 2020-01-10 (Released:2020-01-10)

参考文献数

34

被引用文献数

2 1

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Prediction models are combinations of predictors to assess the risks of specific endpoints such as the presence or prognosis of a disease. Many novel predictors have been developed, modelling techniques have been evolving, and prediction models are currently abundant in the medical literature, especially in cardiovascular medicine, but evidence is still lacking regarding how to use them. Recent methodological advances in systematic reviews and meta-analysis have enabled systematic evaluation of prediction model studies and quantitative analysis to identify determinants of model performance. Knowing what is critical to model performance, under what circumstances model performance remains adequate, and when a model might require further adjustment and improvement will facilitate effective utilization of prediction models and will enhance diagnostic and prognostic accuracy in clinical practice. In this review article, we provide a current methodological overview of the attempts to implement evidence-based utilization of prognostic prediction models for all potential model users, including patients and their families, health-care providers, administrators, researchers, guideline developers and policy makers.

著者

Shunsuke Murata Misa Takegami Daisuke Onozuka Yuriko Nakaoku Akihito Hagihara Kunihiro Nishimura

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.31, no.6, pp.361-368, 2021-06-05 (Released:2021-06-05)

参考文献数

19

被引用文献数

5

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Background: Dementia-related missing and subsequent deaths are becoming serious problems with increases in people with dementia. However, there are no sufficient studies investigating the incidence rate, the mortality rate, and their risk factors.Methods: An ecological study aggregated at the Japanese prefectural level was conducted. Dementia-related missing persons cases and deaths in 2018 were extracted from the statistics of the National Police Agency in Japan. We extracted variables about older adults’ characteristics, care, and safety as candidate variables considered to be relevant to dementia-related missing persons cases and deaths. Associations of the candidate variables with the incidence and mortality rates were analyzed using the generalized linear model (family: quasi-poisson, link: log) adjusted for confounding factors (proportion of older adults and gross prefectural product).Results: The incidence rate and mortality rate per 100,000 person-year was 21.72 and 0.652 in Japan, respectively. One facility increase in the number of nursing care facilities for older adults per 100,000 persons aged 65-years-old or more was associated with a 7.9% (95% confidence interval [CI], 3.3–12.4%) decrease in the incidence rate. One increase in the number of public health nurses per 100,000 persons was associated with a 3.2% (95% CI, 1.6–4.9%) decrease in the incidence rate. A ten percent increase in the proportion of people who live in an urban area was associated with a 20.3% (95% CI, 8.7–33.2%) increase in the incidence rate and a 12.9% (95% CI, 5.6–19.8%) decrease in the mortality rate.Conclusions: Identified associated factors may be useful for managing or predicting dementia-related missing persons cases and associated deaths.

著者

Yukako Tatsumi Aya Higashiyama Yoshimi Kubota Daisuke Sugiyama Yoko Nishida Takumi Hirata Aya Kadota Kunihiro Nishimura Hironori Imano Naomi Miyamatsu Yoshihiro Miyamoto Tomonori Okamura

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.26, no.11, pp.572-578, 2016-11-05 (Released:2016-11-05)

参考文献数

31

被引用文献数

1 15

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Background: Although underweight young women are targets for interventions to prevent low bone mineral density (BMD), the relationship between change in body mass index (BMI) from youth to older age and BMD has not been widely investigated in community dwellers.Methods: In 749 healthy Japanese women aged 40–74 years, BMD was measured by quantitative ultrasound and anthropometric measurements, and BMI was calculated from body weight and height. The BMI of participants at age 20 years was estimated by self-reported body weight and their present height. They were classified into four groups according to the presence of underweight (BMI <18.5 kg/m2) at 20 and/or at present. Logistic regression models were used to estimate multivariate-adjusted odds ratios (ORs) of the presence of underweight at 20 and/or at present for osteopenia (BMD T score <−1 standard deviations) compared with participants with BMI ≥18.5 kg/m2 both at 20 and at present.Results: The participants who were underweight both at 20 and at present had a higher OR for osteopenia compared with those with BMI ≥18.5 kg/m2 at 20 and at present (OR 3.94; 95% confidence interval [CI], 1.97–7.89). Those underweight only at present also had significantly increased OR of developing osteopenia (OR 2.95; 95% CI, 1.67–5.24). The OR of those underweight only at 20 was 0.87 (95% CI, 0.51–1.48).Conclusions: Current underweight was associated with increased risk for osteopenia among Japanese women, especially in those who were underweight both at 20 and at present. To prevent low BMD in the future, maintaining appropriate body weight might be effective for young underweight women.

著者

Shiro Uemura Hiroshi Okamoto Michikazu Nakai Kunihiro Nishimura Yoshihiro Miyamoto Satoshi Yasuda Nobuhiro Tanaka Shun Kohsaka Kazushige Kadota Yoshihiko Saito Hiroyuki Tsutsui Issei Komuro Yuji Ikari Hisao Ogawa Masato Nakamura

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0004, (Released:2019-04-24)

参考文献数

33

被引用文献数

16

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Background:Primary percutaneous coronary intervention (pPCI) is strongly recommended by guidelines for patients presenting with acute myocardial infarction (AMI), but its applications in elderly patients are less clear.Methods and Results:The JROAD-DPC is a Japanese nationwide registry for patients with cardiovascular diseases combined with an administrative claim-based database. Among 2,369,165 records from 2012 to 2015, data for 115,407 AMI patients were extracted for this study. Elderly patients (≥75 years) comprised 45,645 subjects (39.6%), and received pPCI less frequently (62.2%) than younger patients (79.2%, P<0.001). Clinical variables such as higher age, female sex, higher Killip class, and renal dysfunction, but not functional status on admission, were predictors of non-application of pPCI. Endpoint 30-day mortality increased with aging, and was significantly higher in elderly patients (10.7%) than in younger patients (3.8%, P<0.001). Indeed, pPCI was independently associated with lower 30-day mortality only in subgroups of patients aged ≥60 years. Propensity score-matching analysis confirmed a similar reduction in endpoint 30-day mortality with pPCI in elderly patients. Duration of hospitalization was significantly shorter and functional ability on discharge was significantly better in elderly patients who underwent pPCI.Conclusions:Elderly patients with AMI underwent pPCI less frequently, but it was consistently associated with better clinical outcome in these patients. Our findings support the proactive application of pPCI for elderly AMI patients when they are eligible for an invasive strategy.

著者

Masaomi Gohbara Kunihiro Nishimura Michikazu Nakai Yoko Sumita Tsutomu Endo Yasushi Matsuzawa Masaaki Konishi Masami Kosuge Toshiaki Ebina Kouichi Tamura Kazuo Kimura

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.1, no.1, pp.20-28, 2019-01-10 (Released:2019-01-10)

参考文献数

30

被引用文献数

6

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Background: The aim of this study was to clarify the clinical impact of activities of daily living (ADL) using the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database. Methods and Results: From April 2012 to March 2014, the JROAD-DPC database included 206,643 patients with acute coronary syndrome (ACS; n=49,784), heart failure (HF; n=136,878), or aortic aneurysm/dissection (Aorta; n=19,981). We divided them into 3 categories with regard to age (low, 20–59 years; middle, 60–79 years; high, ≥80 years) and admission ADL (low, Barthel index [BI] 0–70; middle, BI 75–95; high, BI 100). ACS, HF, and Aorta patients with low ADL had higher in-hospital mortality rates (18.3%, 16.7%, and 33.4%) than those with middle or high ADL (P<0.001, χ2 test). On multivariable analysis, BI on admission was associated with in-hospital mortality of ACS (OR, 0.986 per 1 BI; P<0.001), HF (OR, 0.986 per 1 BI; P<0.001), and Aorta (OR, 0.986 per 1 BI; P<0.001), adjusted for gender, age, body mass index, hypertension, diabetes mellitus, dyslipidemia, and the Charlson comorbidity index. Moreover, patients with low age and low ADL had a higher in-hospital mortality rate than those with high age and high ADL in regard to HF (8.6% vs. 6.0%). Conclusions: According to JROAD-DPC data, assessment of admission ADL is important in patients with cardiovascular disease.