Toshiyuki Nagai
Mortality after admission for heart failure in the UK compared with Japan
Nagai, Toshiyuki; 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.
Authors
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
Abstract
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.
Citation
Nagai, T., Sundaram, V., Rothnie, K., Quint, J. K., Shoaib, A., Shiraishi, Y., Kohsaka, S., Piper, S., McDonagh, T. A., Hardman, S. M. C., Goda, A., Mizuno, A., Kohno, T., Rigby, A. S., Yoshikawa, T., Clark, A. L., Anzai, T., & Cleland, J. G. (2018). Mortality after admission for heart failure in the UK compared with Japan. Open heart, 5(2), e000811. https://doi.org/10.1136/openhrt-2018-000811
Journal Article Type | Article |
---|---|
Acceptance Date | Apr 24, 2018 |
Online Publication Date | Sep 11, 2018 |
Publication Date | Aug 1, 2018 |
Deposit Date | May 29, 2018 |
Publicly Available Date | Sep 25, 2018 |
Electronic ISSN | 2053-3624 |
Publisher | BMJ Publishing Group |
Peer Reviewed | Peer Reviewed |
Volume | 5 |
Issue | 2 |
Article Number | e000811 |
Pages | e000811 |
DOI | https://doi.org/10.1136/openhrt-2018-000811 |
Keywords | Heart failure and cardiomyopathies |
Public URL | https://hull-repository.worktribe.com/output/853557 |
Publisher URL | https://openheart.bmj.com/content/5/2/e000811 |
Contract Date | May 31, 2018 |
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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: http://creativecommons.org/licenses/by-nc/4.0/.
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