Management and outcomes of heart failure hospitalization among older adults in the United States and Japan

Abstract

Aims: Despite advances in therapies, the disease burden of heart failure (HF) has been rising globally. International comparisons of HF management and outcomes may reveal care patterns that improve outcomes. Accordingly, we examined clinical management and patient outcomes in older adults hospitalized for acute HF in the United States (US) and Japan.

Methods: We identified patients aged >65 who were hospitalized for HF in 2013 using US Medicare data and the Japanese Registry of Acute Decompensated Heart Failure (JROADHF). We described patient characteristics, management, and healthcare utilization and compared outcomes using multivariable Cox regression during and after HF hospitalization.

Results: Among 11 193 Japanese and 120 289 US patients, age and sex distributions were similar, but US patients had higher comorbidity rates. The length of stay was longer in Japan (median 18 vs. 5 days). While Medicare patients had higher use of implantable cardioverter defibrillator or cardiac resynchronization therapy during hospitalization (1.32% vs. 0.6%), Japanese patients were more likely to receive cardiovascular medications at discharge and to undergo cardiac rehabilitation within 3 months of HF admission (31% vs. 1.6%). Physician follow-up within 30 days was higher in Japan (77% vs. 57%). Cardiovascular readmission, cardiovascular mortality and all-cause mortality were 2.1-3.7 times higher in the US patients. The per-day cost of hospitalization was lower in Japan ($516 vs. $1323).

Conclusions: We observed notable differences in the management, outcomes and costs of HF hospitalization between the US and Japan. Large differences in length of hospitalization, cardiac rehabilitation rate and outcomes warrant further research to determine the optimal length of stay and assess the benefits of inpatient cardiac rehabilitation to reduce rehospitalization and mortality.

Keywords: cost; heart failure; in‐hospital management; mortality; rehospitalization.

Figure 1

Physician follow‐up within 30 days of heart failure hospitalization. (A) Follow‐up among Medicare and Japanese Registry of Acute Decompensated Heart Failure (JROADHF) heart failure cohorts. (B) Follow‐up among Medicare‐eligible only, dual Medicare–Medicaid‐eligible and JROADHF heart failure cohorts. This figure displays the time to the first outpatient physician visit within the first 30 days after heart failure hospitalization discharge among patients transferred to another facility, with censoring at death or cardiovascular rehospitalization. Panel (A) displays 30 day physician follow‐up in the JROADHF (n = 5378) and Medicare cohorts overall (n = 49 344); panel (B) displays 30 day physician follow‐up for the JROADHF (n = 5378), Medicare only (n = 40 589) and dual eligibility for Medicare and Medicaid (n = 8755).

Figure 2

Mortality and rehospitalization in Medicare and Japanese Registry of Acute Decompensated Heart Failure (JROADHF) heart failure cohorts. (A) All‐cause mortality after heart failure hospital admission. (B) Cardiovascular mortality after heart failure hospital admission. (C) Cardiovascular readmission after discharge from heart failure hospitalization. This figure displays the time to event for outcomes in the JROADHF and Medicare heart failure cohorts.