TY - JOUR
T1 - Hospitalization for Heart Failure in the United States, UK, Taiwan, and Japan
T2 - An International Comparison of Administrative Health Records on 413,385 Individual Patients
AU - Sundaram, VARUN
AU - NAGAI, TOSHIYUKI
AU - CHIANG, CHERN H.E.R.N.E.N.
AU - REDDY, YOGESH N.V.
AU - CHAO, TZE Z.E.F.A.N.
AU - ZAKERI, ROSITA
AU - BLOOM, CHLOE
AU - NAKAI, MICHIKAZU
AU - NISHIMURA, KUNIHIRO
AU - HUNG, CHUNG H.U.N.G.L.I.E.H.
AU - MIYAMOTO, YOSHIHIRO
AU - YASUDA, SATOSHI
AU - BANERJEE, AMITAVA
AU - ANZAI, TOSHIHISA
AU - SIMON, DANIEL I.
AU - RAJAGOPALAN, SANJAY
AU - CLELAND, JOHN G.F.
AU - SAHADEVAN, JAYAKUMAR
AU - QUINT, JENNIFER K.
N1 - Funding Information:
VS, TN, JKQ, JS, and JGFC conceived and designed the analysis. Standardization and individual matching of diagnoses (cardiac and noncardiac comorbidities) and procedure codes (HRU) across the 4 countries was performed by VS and TN. VS, TN, TFC, and MN did the statistical analysis. All authors contributed to analyzing the data, interpreting the results, drafting the manuscript and the revisions. Supported by the National Institute of Health (NIH 1R21HL140417-01A1), USA; Great Britain Sasakawa Foundation (B114), UK; an d the Japanese Society for the Promotion of Science (JSPS 18K08122), Japan. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Funding Information:
Supported by the National Institute of Health (NIH 1R21HL140417-01A1), USA; Great Britain Sasakawa Foundation (B114), UK; an d the Japanese Society for the Promotion of Science (JSPS 18K08122), Japan. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Publisher Copyright:
© 2021
PY - 2022/3
Y1 - 2022/3
N2 - Background: Registries show international variations in the characteristics and outcome of patients with heart failure (HF), but national samples are rarely large, and case selection may be biased owing to enrolment in academic centers. National administrative datasets provide large samples with a low risk of bias. In this study, we compared the characteristics, health care resource use (HRU) and outcomes of patients with primary HF hospitalizations (HFH) using electronic health records (EHR) from 4 high-income countries (United States, UK, Taiwan, Japan) on 3 continents. Methods and Results: We used electronic health record to identify unplanned HFH between 2012 and 2014. We identified 231,512, 10,991, 36,900, and 133,982 patients with a primary HFH from the United States, the UK, Taiwan, and Japan, respectively. HFH per 100,000 population was highest in the United States and lowest in Taiwan. Fewer patients in Taiwan and Japan were obese or had chronic kidney disease. The length of hospital stay was shortest in the United States (median 4 days) and longer in the UK, Taiwan, and Japan (medians of 7, 9, and 17 days, respectively). HRU during hospitalization was highest in Japan and lowest in UK. Crude and direct standardized in-hospital mortality was lowest in the United States (direct standardized rates 1.8, 95% confidence interval 1.7%–1.9%) and progressively higher in Taiwan (direct standardized rates 3.9, 95% CI 3.8%–4.1%), the UK (direct standardized rates 6.4, 95% CI 6.1%–6.7%), and Japan (direct standardized rates 6.7, 95% CI 6.6%–6.8%). The 30-day all-cause (25.8%) and HF (7.2%) readmissions were highest in the United States and lowest in Japan (11.9% and 5.1%, respectively). Conclusions: Marked international variations in patient characteristics, HRU, and clinical outcomes exist; understanding them might inform health care policy and international trial design.
AB - Background: Registries show international variations in the characteristics and outcome of patients with heart failure (HF), but national samples are rarely large, and case selection may be biased owing to enrolment in academic centers. National administrative datasets provide large samples with a low risk of bias. In this study, we compared the characteristics, health care resource use (HRU) and outcomes of patients with primary HF hospitalizations (HFH) using electronic health records (EHR) from 4 high-income countries (United States, UK, Taiwan, Japan) on 3 continents. Methods and Results: We used electronic health record to identify unplanned HFH between 2012 and 2014. We identified 231,512, 10,991, 36,900, and 133,982 patients with a primary HFH from the United States, the UK, Taiwan, and Japan, respectively. HFH per 100,000 population was highest in the United States and lowest in Taiwan. Fewer patients in Taiwan and Japan were obese or had chronic kidney disease. The length of hospital stay was shortest in the United States (median 4 days) and longer in the UK, Taiwan, and Japan (medians of 7, 9, and 17 days, respectively). HRU during hospitalization was highest in Japan and lowest in UK. Crude and direct standardized in-hospital mortality was lowest in the United States (direct standardized rates 1.8, 95% confidence interval 1.7%–1.9%) and progressively higher in Taiwan (direct standardized rates 3.9, 95% CI 3.8%–4.1%), the UK (direct standardized rates 6.4, 95% CI 6.1%–6.7%), and Japan (direct standardized rates 6.7, 95% CI 6.6%–6.8%). The 30-day all-cause (25.8%) and HF (7.2%) readmissions were highest in the United States and lowest in Japan (11.9% and 5.1%, respectively). Conclusions: Marked international variations in patient characteristics, HRU, and clinical outcomes exist; understanding them might inform health care policy and international trial design.
KW - Heart failure
KW - Japan
KW - Taiwan
KW - United Kingdom
KW - United States
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=85118974440&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85118974440&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2021.08.024
DO - 10.1016/j.cardfail.2021.08.024
M3 - Article
C2 - 34634448
AN - SCOPUS:85118974440
SN - 1071-9164
VL - 28
SP - 353
EP - 366
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 3
ER -