RT Journal Article
SR Electronic
T1 Mortality after admission for heart failure in the UK compared with Japan
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000811
DO 10.1136/openhrt-2018-000811
VO 5
IS 2
A1 Toshiyuki Nagai
A1 Varun Sundaram
A1 Kieran Rothnie
A1 Jennifer Kathleen Quint
A1 Ahmad Shoaib
A1 Yasuyuki Shiraishi
A1 Shun Kohsaka
A1 Susan Piper
A1 Theresa A McDonagh
A1 Suzanna Marie C Hardman
A1 Ayumi Goda
A1 Atsushi Mizuno
A1 Takashi Kohno
A1 Alan S Rigby
A1 Tsutomu Yoshikawa
A1 Andrew L Clark
A1 Toshihisa Anzai
A1 John G F Cleland
YR 2018
UL http://openheart.bmj.com/content/5/2/e000811.abstract
AB Objective Mortality amongst patients hospitalised for heart failure (HHF) in Western and Asian countries may differ, but this has not been investigated using individual patient-level data (IPLD). We sought to remedy this through rigorous statistical analysis of HHF registries and variable selection from a systematic literature review.Methods and results IPLD from registries of HHF in Japan (n=3781) and the UK (n=894) were obtained. A systematic literature review identified 23 models for predicting outcome of HHF. Five variables appearing in 10 or more reports were strongly related to prognosis (systolic blood pressure, serum sodium concentration, age, blood urea nitrogen and creatinine). To compare mortality in the UK and Japan, variables were imputed in a propensity model using inverse probability of treatment weighting (IPTW) and IPTW with logistic regression (doubly robust IPTW). Overall, patients in the UK were sicker and in-patient and post-discharge mortalities were greater, suggesting that the threshold for hospital admission was higher. Covariate-adjusted in-hospital mortality was similar in the UK and Japan (IPTW OR: 1.14, 95% CI 0.70 to 1.86), but 180-day postdischarge mortality was substantially higher in the UK (doubly robust IPTW OR: 2.33, 95% CI 1.58 to 3.43).Conclusions Despite robust methods to adjust for differences in patient characteristics and disease severity, HHF patients in the UK have roughly twice the mortality at 180 days compared with those in Japan. Similar analyses should be done using other data sets and in other countries to determine the consistency of these findings and identify factors that might inform healthcare policy and improve outcomes.