Abstract：
OBJECTIVE: 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.
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.
摘要：
目标：尽管疗法取得了进展，心力衰竭（HF）的疾病负担在全球范围内一直在上升。HF管理和结果的国际比较可能揭示改善结果的护理模式。因此，我们研究了在美国(US)和日本因急性HF住院的老年人的临床治疗和患者结局.
方法：我们使用美国医疗保险数据和日本急性失代偿性心力衰竭注册（JROADHF），确定了2013年因心力衰竭住院的65岁以上患者。我们描述了患者特征，管理,和医疗保健利用，并使用多变量Cox回归比较HF住院期间和之后的结果。
结果：在11.193日本患者和120.289美国患者中，年龄和性别分布相似，但美国患者的合并症发生率较高。在日本，住院时间更长（中位数为18vs.5天）。虽然Medicare患者在住院期间使用植入式心律转复除颤器或心脏再同步治疗的比例较高(1.32%vs.0.6%），日本患者更有可能在出院时接受心血管药物治疗，并在HF入院后3个月内接受心脏康复（31％vs.1.6%）。日本的医师在30天内的随访率较高（77%vs.57%）。心血管再入院,美国患者的心血管死亡率和全因死亡率高出2.1-3.7倍.日本每天的住院费用较低(516美元vs.1323美元)。
结论：我们观察到管理方面的显著差异，美国和日本之间HF住院的结局和费用。住院时间差异很大，心脏康复率和结局需要进一步研究,以确定最佳住院时间,并评估住院心脏康复对降低再住院率和死亡率的益处.
方法：我们使用美国医疗保险数据和日本急性失代偿性心力衰竭注册（JROADHF），确定了2013年因心力衰竭住院的65岁以上患者。我们描述了患者特征，管理,和医疗保健利用，并使用多变量Cox回归比较HF住院期间和之后的结果。
结果：在11.193日本患者和120.289美国患者中，年龄和性别分布相似，但美国患者的合并症发生率较高。在日本，住院时间更长（中位数为18vs.5天）。虽然Medicare患者在住院期间使用植入式心律转复除颤器或心脏再同步治疗的比例较高(1.32%vs.0.6%），日本患者更有可能在出院时接受心血管药物治疗，并在HF入院后3个月内接受心脏康复（31％vs.1.6%）。日本的医师在30天内的随访率较高（77%vs.57%）。心血管再入院,美国患者的心血管死亡率和全因死亡率高出2.1-3.7倍.日本每天的住院费用较低(516美元vs.1323美元)。
结论：我们观察到管理方面的显著差异，美国和日本之间HF住院的结局和费用。住院时间差异很大，心脏康复率和结局需要进一步研究,以确定最佳住院时间,并评估住院心脏康复对降低再住院率和死亡率的益处.
