Chronic heart failure in Japan: implications of the CHART studies

Abstract

The prognosis of patients with chronic heart failure (CHF) still remains poor, despite the recent advances in medical and surgical treatment. Furthermore, CHF is a major public health problem in most industrialized countries where the elderly population is rapidly increasing. Although the prevalence and mortality of CHF used to be relatively low in Japan, the disorder has been markedly increasing due to the rapid aging of the society and the Westernization of lifestyle that facilitates the development of coronary artery disease. The Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART)-1 study was one of the largest cohorts in Japan. The study has clarified the characteristics and prognosis of Japanese patients with CHF, demonstrating that their prognosis was similarly poor compared with those in Western countries. However, we still need evidence for the prevention and treatment of CHF based on the large cohort studies or randomized treatment trials in the Japanese population. Since the strategy for CHF management is now changing from treatment to prevention, a larger-size prospective cohort, called the CHART-2 study, has been initiated to evaluate the risk factors of CHF in Japan. This review summarizes the current status of CHF studies in Japan and discusses their future perspectives.

Keywords: Japanese; aging; heart failure.

Figure 1

Time-course and future prediction of the increase in elderly population and heart-disease mortality in Japan. Data are based on the Status of Aging and Implementation of Measures for Aging Society in 2005, reported by the Japanese Cabinet.

Figure 2

Prognosis of the Japanese patients with CHF in the CHART-1 study. Copyright © 2004. Reproduced with permission from Shiba N, Watanabe J, Shinozaki T, et al. 2004. Analysis of chronic heart failure registry in the Tohoku district: third year follow-up. Circ J, 68:427–34. Abbreviations: HF, heart failure.

Figure 3

Kaplan-Meier curves of freedom from all-cause death stratified by (A) BNP and (B) LVEF in the CHART-1 study. Abbreviations: BNP, B-type natriuretic peptide; LVEF, left ventricular ejection fraction.

Figure 4

Prevalence of the use of renin-angiotensin inhibitors and β-blockers in the CHART-1 study. Copyright © 2007. Reproduced with permission from Shiba N, Takahashi J, Matsuki M. 2007. The CHART Study (Japanese). Naika, 99:410–14. Abbreviations: ACEI, angiotensin-converting-enzyme inhibitor; ARB, angiotensin II receptor blocker; CAD, coronary artery disease; NICM, non-ischemic cardiomyopathy; LVH, left ventricular hypertrophy; VHD, valvular heart disease.

Figure 5

Comparison of the prognosis of patients with CHF between Western clinical trials and the CHART-1 study. Copyright © 2007. Reproduced with permission from Shiba N, Takahashi J, Matsuki M. 2007. The CHART Study (Japanese). Naika, 99:410–14. Abbreviations: HYHA, New York Heart Association.

Figure 6

Prognosis of elderly patients with CHF in the CHART-1 study. Copyright © 2007. Reproduced with permission from Shiba N, Takahashi J, Matsuki M. 2007. The CHART Study (Japanese). Naika, 99:410–14. Abbreviations: CHF, congestive heart failure.