Varun Sundaram1, Toshiyuki Nagai2, Chern-En Chiang3, Yogesh N V Reddy4, Tze-Fan Chao5, Rosita Zakeri6, Chloe Bloom7, Michikazu Nakai8, Kunihiro Nishimura8, Chung-Lieh Hung9, Yoshihiro Miyamoto10, Satoshi Yasuda10, Amitava Banerjee11, Toshihisa Anzai12, Daniel I Simon7, Sanjay Rajagopalan13, John G F Cleland14, Jayakumar Sahadevan15, Jennifer K Quint16. 1. Department of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, Ohio; Department of Cardiovascular Medicine, Harington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Population Science and Gene Health, National Heart & Lung Institute, Imperial College London, London, UK; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: vxs173@case.edu. 2. Department of Population Science and Gene Health, National Heart & Lung Institute, Imperial College London, London, UK; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan. 3. General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. 4. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. 5. General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. 6. Department of Population Science and Gene Health, National Heart & Lung Institute, Imperial College London, London, UK; Kings College London, London, UK. 7. Department of Population Science and Gene Health, National Heart & Lung Institute, Imperial College London, London, UK. 8. Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Japan. 9. Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC; Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, ROC. 10. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. 11. Institute of Health Informatics, University College London, London, UK. 12. Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan. 13. Department of Cardiovascular Medicine, Harington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio. 14. Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK. 15. Department of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, Ohio; Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK. Electronic address: jxs47@case.edu. 16. Department of Population Science and Gene Health, National Heart & Lung Institute, Imperial College London, London, UK; The Department of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, Ohio.
Abstract
BACKGROUND: Registries show international variations in the characteristics and outcome of patients with heart failure (HF), but national samples are rarely large, and case selection may be biased owing to enrolment in academic centers. National administrative datasets provide large samples with a low risk of bias. In this study, we compared the characteristics, health care resource use (HRU) and outcomes of patients with primary HF hospitalizations (HFH) using electronic health records (EHR) from 4 high-income countries (United States, UK, Taiwan, Japan) on 3 continents. METHODS AND RESULTS: We used electronic health record to identify unplanned HFH between 2012 and 2014. We identified 231,512, 10,991, 36,900, and 133,982 patients with a primary HFH from the United States, the UK, Taiwan, and Japan, respectively. HFH per 100,000 population was highest in the United States and lowest in Taiwan. Fewer patients in Taiwan and Japan were obese or had chronic kidney disease. The length of hospital stay was shortest in the United States (median 4 days) and longer in the UK, Taiwan, and Japan (medians of 7, 9, and 17 days, respectively). HRU during hospitalization was highest in Japan and lowest in UK. Crude and direct standardized in-hospital mortality was lowest in the United States (direct standardized rates 1.8, 95% confidence interval 1.7%-1.9%) and progressively higher in Taiwan (direct standardized rates 3.9, 95% CI 3.8%-4.1%), the UK (direct standardized rates 6.4, 95% CI 6.1%-6.7%), and Japan (direct standardized rates 6.7, 95% CI 6.6%-6.8%). The 30-day all-cause (25.8%) and HF (7.2%) readmissions were highest in the United States and lowest in Japan (11.9% and 5.1%, respectively). CONCLUSIONS: Marked international variations in patient characteristics, HRU, and clinical outcomes exist; understanding them might inform health care policy and international trial design. Published by Elsevier Inc.
BACKGROUND: Registries show international variations in the characteristics and outcome of patients with heart failure (HF), but national samples are rarely large, and case selection may be biased owing to enrolment in academic centers. National administrative datasets provide large samples with a low risk of bias. In this study, we compared the characteristics, health care resource use (HRU) and outcomes of patients with primary HF hospitalizations (HFH) using electronic health records (EHR) from 4 high-income countries (United States, UK, Taiwan, Japan) on 3 continents. METHODS AND RESULTS: We used electronic health record to identify unplanned HFH between 2012 and 2014. We identified 231,512, 10,991, 36,900, and 133,982 patients with a primary HFH from the United States, the UK, Taiwan, and Japan, respectively. HFH per 100,000 population was highest in the United States and lowest in Taiwan. Fewer patients in Taiwan and Japan were obese or had chronic kidney disease. The length of hospital stay was shortest in the United States (median 4 days) and longer in the UK, Taiwan, and Japan (medians of 7, 9, and 17 days, respectively). HRU during hospitalization was highest in Japan and lowest in UK. Crude and direct standardized in-hospital mortality was lowest in the United States (direct standardized rates 1.8, 95% confidence interval 1.7%-1.9%) and progressively higher in Taiwan (direct standardized rates 3.9, 95% CI 3.8%-4.1%), the UK (direct standardized rates 6.4, 95% CI 6.1%-6.7%), and Japan (direct standardized rates 6.7, 95% CI 6.6%-6.8%). The 30-day all-cause (25.8%) and HF (7.2%) readmissions were highest in the United States and lowest in Japan (11.9% and 5.1%, respectively). CONCLUSIONS: Marked international variations in patient characteristics, HRU, and clinical outcomes exist; understanding them might inform health care policy and international trial design. Published by Elsevier Inc.
Entities:
Keywords:
Heart failure; Japan; Taiwan; United Kingdom; United States; outcomes
Authors: Sven H Loosen; Christoph Roderburg; Ole Curth; Julia Gaensbacher; Markus Joerdens; Tom Luedde; Marcel Konrad; Karel Kostev; Mark Luedde Journal: Sci Rep Date: 2022-02-17 Impact factor: 4.379