Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 Jun;6(3):475-486.
doi: 10.1002/ehf2.12418. Epub 2019 Mar 3.

Clinical characteristics of hospitalized heart failure patients with preserved, mid-range, and reduced ejection fractions in Japan

Tsuyoshi Shiga  1 , Atsushi Suzuki  1 , Shoji Haruta  2 , Fumiaki Mori  3 , Yoshimi Ota  4 , Masahiro Yagi  5 , Toshiaki Oka  6 , Hiroyuki Tanaka  7 , Satoshi Murasaki  8 , Takao Yamauchi  9 , Joji Katoh  10 , Hidetoshi Hattori  1 , Noriko Kikuchi  1 , Erisa Watanabe  1 , Yuichiro Yamada  2 , Shintaro Haruki  1 , Tomohito Kogure  1 , Tsuyoshi Suzuki  1   11 , Yoshio Uetsuka  12 , Nobuhisa Hagiwara  1 ; HIJ-HF II Investigators
Affiliations
Multicenter Study

Clinical characteristics of hospitalized heart failure patients with preserved, mid-range, and reduced ejection fractions in Japan

Tsuyoshi Shiga et al. ESC Heart Fail. 2019 Jun.

Abstract

Aims: There are regional differences in the patient characteristics, management, and outcomes of hospitalized patients with heart failure (HF). The aim of this study was to evaluate the clinical characteristics and outcomes of Japanese patients who are hospitalized with HF on the basis of the left ventricular ejection fraction (LVEF) stratum.

Methods and results: We retrospectively conducted a multicentre cohort study of 1245 hospitalized patients with decompensated HF between 2013 and 2014. Of these patients, 36% had an LVEF < 40% [HF with reduced ejection fraction (HFrEF), median age 72 years, 71% male], 21% had an LVEF 40-49% [HF with mid-range EF (HFmrEF), 77 years, 56% male], and 43% had an LVEF ≥ 50% [HF with preserved EF (HFpEF), 81 years, 44% male]. The primary outcome was death from any cause, and the secondary outcomes were cardiac death and re-hospitalization due to worsened HF after hospital discharge. There were high proportions of non-ischaemic cardiomyopathy (32%) in HFrEF patients, coronary artery disease (44%) in HFmrEF patients, and valvular disease (39%) in HFpEF patients. The frequencies of intravenous diuretic and natriuretic peptide administration during hospitalization were 66% and 30%, respectively. The median hospital stay for the overall population was 19 days, and the length of stay was >7 days for >90% of patients. In-hospital mortality was 7%, but was not different among the LVEF groups (HFrEF 7%, HFmrEF 6%, and HFpEF 8%). After a median follow-up of 19 months (range, 3-26 months), 192 (17%) of the 1156 patients who were discharged alive died, and 534 (46%) were re-hospitalized after hospital discharge. There were no significant differences in mortality after hospital discharge among the three LVEF groups (HFrEF 18%, HFmrEF 16%, and HFpEF 16%). There were no differences in cardiac death or re-hospitalization due to worsened HF after hospital discharge among the LVEF groups (cardiac death: HFrEF 8%, HFmrEF 7%, and HFpEF 7%; re-hospitalization due to worsened HF: HFrEF 19%, HFmrEF 16%, and HFpEF 17%). Multivariable-adjusted analyses showed that the HFmrEF and HFrEF groups, compared with the HFpEF group, were not associated with an increased risk for in-hospital death or death after hospital discharge. Non-cardiac causes of death and re-hospitalization after hospital discharge accounted for 35% and 38%, respectively.

Conclusions: Our results revealed different clinical characteristics but similar mortality rates in the HFrEF, HFmrEF, and HFpEF groups. The most common cause of death and re-hospitalization after hospital discharge was HF, but non-cardiac causes also contributed to their prognosis. Integrated management approaches will be required for HF patients.

Keywords: Heart failure; Hospitalization; Japanese; Left ventricular ejection fraction; Mortality.

PubMed Disclaimer

Conflict of interest statement

Dr Shiga received lecture fees from Eisai, Toa Eiyo, Bayer, and Daiichi‐Sankyo. Dr Hagiwara received research funding from Eisai, Nippon Boehringer Ingelheim, and Daiichi‐Sankyo and received lecture fees from Nippon Boehringer Ingelheim and Bristol‐Myers Squibb. The other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for mortality in patients with HFrEF, HFmrEF, and HFpEF.
Figure 2
Figure 2
Kaplan–Meier curves for cardiac death (A) and re‐hospitalization due to worsening HF (B) in patients with HFrEF, HFmrEF, and HFpEF.
See this image and copyright information in PMC

References

    1. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, Nodari S, Lam CSP, Sato N, Shah AN, Gheorghiade M. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 2014; 63: 1123–1133. - PubMed
    1. Roger VL. Epidemiology of heart failure. Circ Res 2013; 113: 646–659. - PMC - PubMed
    1. Sakata Y, Shimokawa H. Epidemiology of heart failure in Asia. Circ J 2013; 77: 2209–2217. - PubMed
    1. Okamoto H, Kitabatake A. The epidemiology of heart failure in Japan. Nihon Rinsho 2003; 61: 709–714 (in Japanese). - PubMed
    1. Okura Y, Ramadan MM, Ohno Y, Mitsuma W, Tanaka K, Ito M, Suzuki K, Tanabe N, Kodama M, Aizawa Y. Impending epidemic: future projection of heart failure in Japan to the year 2055. Circ J 2008; 72: 489–491. - PubMed

Publication types