Skip to main content

Mortality after admission for heart failure in the UK compared with Japan

Rigby, Alan; Nagai, Toshiyuki; Clark, Andrew; Sundaram, Varun; Rothnie, Kieran; Quint, Jennifer Kathleen; Shoaib, Ahmad; Shiraishi, Yasuyuki; Kohsaka, Shun; Piper, Susan; McDonagh, Theresa A.; Hardman, Suzanna Marie C.; Goda, Ayumi; Mizuno, Atsushi; Kohno, Takashi; Rigby, Alan S.; Yoshikawa, Tsutomu; Clark, Andrew L.; Anzai, Toshihisa; Cleland, John G.F.


Alan Rigby

Toshiyuki Nagai

Andrew Clark

Varun Sundaram

Kieran Rothnie

Jennifer Kathleen Quint

Ahmad Shoaib

Yasuyuki Shiraishi

Shun Kohsaka

Susan Piper

Theresa A. McDonagh

Suzanna Marie C. Hardman

Ayumi Goda

Atsushi Mizuno

Takashi Kohno

Alan S. Rigby

Tsutomu Yoshikawa

Andrew L. Clark

Toshihisa Anzai

John G.F. Cleland


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.

Journal Article Type Article
Publication Date Aug 1, 2018
Electronic ISSN 2053-3624
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 5
Issue 2
Article Number e000811
Pages e000811
APA6 Citation Nagai, T., Sundaram, V., Rothnie, K., Quint, J. K., Shoaib, A., Shiraishi, Y., …Cleland, J. G. (2018). Mortality after admission for heart failure in the UK compared with Japan. Open heart, 5(2), e000811.
Keywords Heart failure and cardiomyopathies
Publisher URL


Article (429 Kb)

Copyright Statement
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

You might also like

Downloadable Citations