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  • 1
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    Insomnia in patients with acute heart failure: from the KCHF registry
    Wiley ; 2022
    In:  ESC Heart Failure Vol. 9, No. 5 ( 2022-10), p. 2988-2996
    Details
    In: ESC Heart Failure, Wiley, Vol. 9, No. 5 ( 2022-10), p. 2988-2996
    Abstract: Insomnia is a known risk factor for heart failure (HF) and a predictor of cardiac events in HF patients, but the clinical significance of insomnia in patients with acute HF (AHF) is not adequately evaluated. This study aimed to investigate the association between insomnia and subsequent clinical outcomes in patients with AHF. Methods From the Kyoto Congestive Heart Failure registry, consecutive 3414 patients hospitalized for HF who were discharged alive were divided into the 2 groups at discharge: insomnia group and non‐insomnia group. We compared baseline characteristics and 1 year clinical outcomes according to the presence of insomnia. The primary outcome measure was all‐cause death. Results There were 330 patients (9.7%) and 3084 patients (90.3%) with and without insomnia, respectively. In the multivariable logistic regression analysis, brain‐type natriuretic peptide above median value at discharge (OR = 1.50, 95% CI = 1.08–2.10, P  = 0.02) and the presence of oedema at discharge (OR = 4.23, 95% CI = 2.95–6.07, P   〈  0.001) were positively associated with insomnia at discharge, whereas diuretics at discharge (OR = 0.60, 95% CI = 0.39–0.90, P  = 0.01) were negatively associated with insomnia at discharge. The cumulative 1 year incidence of all‐cause death was significantly higher in the insomnia group than in the non‐insomnia group (25.1% vs. 16.2%, P   〈  0.001). Even after adjusting the confounders, the higher mortality risk of patients with insomnia relative to those without insomnia remained significant (HR = 1.55, 95% CI = 1.24–1.94; P   〈  0.001). Conclusions Patients with insomnia at discharge were associated with a higher risk of mortality than those without insomnia at discharge.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v9.5
    DOI: 10.1002/ehf2.14025
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 2
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    Association between changes in loop diuretic dose and outcomes in acute heart failure
    Wiley ; 2023
    In:  ESC Heart Failure Vol. 10, No. 3 ( 2023-06), p. 1757-1770
    Details
    In: ESC Heart Failure, Wiley, Vol. 10, No. 3 ( 2023-06), p. 1757-1770
    Abstract: Little is known about the association between the starting of or dose changes in loop diuretics during acute heart failure (AHF) hospitalization and post‐discharge outcomes. We investigated the clinical impact of starting loop diuretics and changing the loop diuretics dose during hospitalization on post‐discharge outcomes. Methods and results From the Kyoto Congestive Heart Failure registry, 3665 consecutive patients hospitalized for HF and discharged alive were included in this study. We analysed 1906 patients without loop diuretics on admission and were discharged alive and 1759 patients who received loop diuretics on admission and were discharged alive. The primary outcome measure was all‐cause death. Of the 1906 patients without loop diuretics on admission, 1366 (71.7%) patients started loop diuretics during the index AHF hospitalization. Starting loop diuretics was not associated with lower post‐discharge mortality [adjusted hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.68–1.25]. Of the 1759 patients who received loop diuretics on admission, loop diuretic dose was decreased in 23.8%, unchanged in 44.6%, and increased in 31.6% of the patients. Changes in the dose at discharge compared with no change in dose were not associated with lower risk of post‐discharge mortality (decrease relative to no change: adjusted HR 0.98, 95% CI 0.76–1.28; increase relative to no change: adjusted HR 1.00, 95% CI 0.78–1.27). Compared w ith no loop diuretics at discharge, a loop diuretics dose of ≥80 mg at discharge was associated with higher post‐discharge mortality risk. Conclusions In patients with AHF, we found no association between the starting of loop diuretics and post‐discharge outcomes and between dose changes and post‐discharge outcomes.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v10.3
    DOI: 10.1002/ehf2.14338
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 3
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    The characteristics and outcomes in patients with acute heart failure who used tolvaptan: from KCHF registry
    Wiley ; 2023
    In:  ESC Heart Failure
    Details
    In: ESC Heart Failure, Wiley
    Abstract: The use of tolvaptan is increasing in clinical practice in Japan. However, the characteristics of patients who used tolvaptan and the timing of its use in patients with acute heart failure (AHF) are not fully elucidated. Methods and results Among consecutive 4056 patients in the Kyoto Congestive Heart Failure registry, we analysed 3802 patients after excluding patients on dialysis, prior or unknown tolvaptan use at admission, and unknown timing of tolvaptan use, and we divided them into two groups: tolvaptan use ( N  = 773) and no tolvaptan use ( N  = 3029). The prevalence of tolvaptan use varied widely from 48.7% to 0% across the participating centres. Factors independently associated with tolvaptan use were diabetes, poor medical adherence, oedema, pleural effusion, hyponatraemia, estimated glomerular filtration rate  〈  30 mL/min/1.73 m 2 , moderate/severe tricuspid regurgitation, dobutamine infusion within 24 h, and additional inotropes infusion beyond 24 h after admission. The mortality rate at 90 days after admission was significantly higher in the tolvaptan use group than in the no tolvaptan use group (14.3% vs. 8.6%, P  = 0.049). However, after adjustment, the excess mortality risk of tolvaptan use relative to no tolvaptan use was no longer significant (hazard ratio = 1.53, 95% confidence interval = 0.77–3.02, P  = 0.22). Patients with tolvaptan use had a longer hospital stay [median (interquartile range): 22 (15–34) days vs. 15 (11–21) days, P   〈  0.0001] and a higher prevalence of worsening renal failure (47.0% vs. 31.8%, P   〈  0.0001) and worsening heart failure (24.8% vs. 14.4%, P   〈  0.0001) than those without. Conclusions AHF patients with tolvaptan use had more congestive status with poorer in‐hospital outcomes and higher short‐term mortality than those without tolvaptan use. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) and https://upload.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238).
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Article
    DOI: 10.1002/ehf2.14494
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 4
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    Coronary angiography in patients with acute heart failure: from the KCHF registry
    Wiley ; 2022
    In:  ESC Heart Failure Vol. 9, No. 1 ( 2022-02), p. 531-544
    Details
    In: ESC Heart Failure, Wiley, Vol. 9, No. 1 ( 2022-02), p. 531-544
    Abstract: Little is known about the characteristics and outcomes of patients who undergo coronary angiography during heart failure (HF) hospitalization, as well as those with coronary stenosis, and those who underwent coronary revascularization. Methods and results We analysed 2163 patients who were hospitalized for HF without acute coronary syndrome or prior HF hospitalization. We compared patient characteristics and 1 year clinical outcomes according to (i) patients with versus without coronary angiography, (ii) patients with versus without coronary stenosis, and (iii) patients with versus without coronary revascularization. The primary outcome measure was the composite of all‐cause death or HF hospitalization. Coronary angiography was performed in 37.0% of patients. In the multivariable logistic regression analysis, factors independently associated with coronary angiography were age  〈  80 years [adjusted odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.41–2.20, P   〈  0.001], men (adjusted OR = 1.28, 95% CI = 1.03–1.59, P  = 0.02), diabetes (adjusted OR = 1.27, 95% CI = 1.02–1.60, P  = 0.04), no atrial fibrillation or flutter (adjusted OR = 1.45, 95% CI = 1.17–1.82, P   〈  0.001), no prior device implantation (adjusted OR = 1.81, 95% CI = 1.13–2.91, P  = 0.01), current smoking (adjusted OR = 1.40, 95% CI = 1.05–1.87, P  = 0.02), no cognitive dysfunction (adjusted OR = 1.90, 95% CI = 1.34–2.69, P   〈  0.001), ambulatory status (adjusted OR = 2.89, 95% CI = 2.03–4.10, P   〈  0.001), HF with reduced ejection fraction (adjusted OR = 1.55, 95% CI = 1.24–1.93, P   〈  0.001), estimated glomerular filtration rate ≥ 30 mL/min/1.73 m 2 (adjusted OR = 1.93, 95% CI = 1.45–2.58, P   〈  0.001), no anaemia (adjusted OR = 1.27, 95% CI = 1.02–1.59, P  = 0.04), and no prescription of β‐blockers prior to admission (adjusted OR = 1.32, 95% CI = 1.03–1.68, P  = 0.03). Patients who underwent coronary angiography had a lower risk of the primary outcome [adjusted hazard ratio (HR) = 0.70, 95% CI = 0.58–0.85, P   〈  0.001]. Among the patients who underwent coronary angiography, those with coronary stenosis (38.9%) did not have lower risk of the primary outcome measure than those without coronary stenosis (adjusted HR = 0.93, 95% CI = 0.65–1.32, P  = 0.68). Among the patients with coronary stenosis, those with coronary revascularization (54.3%) did not have higher risk of the primary outcome measure than those without coronary revascularization (adjusted HR = 1.36, 95% CI = 0.84–2.21, P  = 0.22). Conclusions In patients with acute HF, patients who underwent coronary angiography had a lower risk of clinical outcomes and were significantly different from those who did not undergo coronary angiography.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v9.1
    DOI: 10.1002/ehf2.13716
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 5
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    Left atrial reverse remodeling improves risk stratification in patients with heart failure with recovered ejection fraction
    Springer Science and Business Media LLC ; 2022
    In:  Scientific Reports Vol. 12, No. 1 ( 2022-03-16)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-03-16)
    Abstract: We aimed to investigate the relationship between left atrial (LA) reverse remodeling and prognosis of heart failure (HF) with recovered ejection fraction (EF) (HFrecEF). Among 1,246 patients with acute heart failure enrolled in the prospective longitudinal follow-up study, 397 patients with HF with mildly-reduced EF and with reduced EF at discharge were analyzed. Echocardiography was performed during the index hospitalization and at the 6-month follow-up after discharge. They were divided into non-HFrecEF (n = 227) and HFrecEF (n = 170) groups. The primary outcome measure was a composite of all-cause death or hospitalization for HF. The cumulative 180-day incidence of the primary outcome measure after follow-up echocardiography was significantly lower in the HFrecEF group than in the non-HFrecEF group (8.9% versus 23.4%, log-rank P = 0.0002). LA reverse remodeling was associated with a lower cumulative 6-month incidence of the primary outcome measure in the HFrecEF group (4.7% versus 18.0%; HR: 0.27, 95%CI: 0.09–0.79, P = 0.01), but not in the non-HFrecEF group (24.4% versus 22.6%; HR: 1.13, 95%CI: 0.65–1.96, P = 0.28) with a significant LA reverse remodeling-by-HFrecEF interaction (P for interaction = 0.02). Combination of left ventricular and atrial reverse remodeling may help in improving HF risk stratification.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-022-08630-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 6
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    Weight loss during follow-up in patients with acute heart failure: From the KCHF registry
    Public Library of Science (PLoS) ; 2023
    In:  PLOS ONE Vol. 18, No. 6 ( 2023-6-23), p. e0287637-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 6 ( 2023-6-23), p. e0287637-
    Abstract: The prognostic implication of weight loss after discharge from acute heart failure (AHF) remains unclear. We sought to investigate the association of weight loss between discharge and 6-month visit with subsequent clinical outcomes in patients with AHF. Methods We analyzed 686 patients with AHF in the prospective longitudinal follow-up study derived from the Kyoto Congestive Heart Failure registry, and divided them into 2 groups based on the weight loss at 6-month index visit. We defined the weight loss as ≥ 5% decrease in body weight from discharge to 6-month index visit. Results There were 90 patients (13.1%) with a weight loss at 6-month visit. Patients in the weight loss group compared with those in the no weight loss group had higher body weight at discharge and lower body weight at 6-mont visit. Patients in the weight loss group had a lower systolic blood pressure, higher brain-type natriuretic peptide, lower serum albumin, lower hemoglobin, higher prevalence of heart failure with reduced ejection fraction at 6-month visit, and a lower prescription rate of inhibitors of renin-angiotensin system than those in the no weight loss group. The cumulative 6-month incidence of all-cause death was significantly higher in the weight loss group than in the no weight loss group (14.2% and 4.3%, log-rank P 〈 0.001). The excess adjusted risk of the weight loss group relative to the no weight loss group remained significant for all-cause death (HR 2.39, 95%CI 1.01–5.65, P = 0.048). Conclusion Body weight loss of ≥5% at 6-month visit after discharge was associated with subsequent all-cause death in patients with AHF.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
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    DOI: 10.1371/journal.pone.0287637
    DOI: 10.1371/journal.pone.0287637.g001
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    DOI: 10.1371/journal.pone.0287637.t001
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    DOI: 10.1371/journal.pone.0287637.r001
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    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2023
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  • 7
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    Development of interpretable machine learning models to predict in‐hospital prognosis of acute heart failure patients
    Wiley ; 2024
    In:  ESC Heart Failure
    Details
    In: ESC Heart Failure, Wiley
    Abstract: In recent years, there has been remarkable development in machine learning (ML) models, showing a trend towards high prediction performance. ML models with high prediction performance often become structurally complex and are frequently perceived as black boxes, hindering intuitive interpretation of the prediction results. We aimed to develop ML models with high prediction performance, interpretability, and superior risk stratification to predict in‐hospital mortality and worsening heart failure (WHF) in patients with acute heart failure (AHF). Methods and results Based on the Kyoto Congestive Heart Failure registry, which enrolled 4056 patients with AHF, we developed prediction models for in‐hospital mortality and WHF using information obtained on the first day of admission (demographics, physical examination, blood test results, etc.). After excluding 16 patients who died on the first or second day of admission, the original dataset ( n  = 4040) was split 4:1 into training ( n  = 3232) and test datasets ( n  = 808). Based on the training dataset, we developed three types of prediction models: (i) the classification and regression trees (CART) model; (ii) the random forest (RF) model; and (iii) the extreme gradient boosting (XGBoost) model. The performance of each model was evaluated using the test dataset, based on metrics including sensitivity, specificity, area under the receiver operating characteristic curve (AUC), Brier score, and calibration slope. For the complex structure of the XGBoost model, we performed SHapley Additive exPlanations (SHAP) analysis, classifying patients into interpretable clusters. In the original dataset, the proportion of females was 44.8% (1809/4040), and the average age was 77.9 ± 12.0. The in‐hospital mortality rate was 6.3% (255/4040) and the WHF rate was 22.3% (900/4040) in the total study population. In the in‐hospital mortality prediction, the AUC for the XGBoost model was 0.816 [95% confidence interval (CI): 0.815–0.818], surpassing the AUC values for the CART model (0.683, 95% CI: 0.680–0.685) and the RF model (0.755, 95% CI: 0.753–0.757). Similarly, in the WHF prediction, the AUC for the XGBoost model was 0.766 (95% CI: 0.765–0.768), outperforming the AUC values for the CART model (0.688, 95% CI: 0.686–0.689) and the RF model (0.713, 95% CI: 0.711–0.714). In the XGBoost model, interpretable clusters were formed, and the rates of in‐hospital mortality and WHF were similar among each cluster in both the training and test datasets. Conclusions The XGBoost models with SHAP analysis provide high prediction performance, interpretability, and reproducible risk stratification for in‐hospital mortality and WHF for patients with AHF.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Article
    DOI: 10.1002/ehf2.14834
    Language: English
    Publisher: Wiley
    Publication Date: 2024
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  • 8
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    Improved and new-onset anemia during follow-up in patients with acute decompensated heart failure : Characteristics and outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Medicine Vol. 100, No. 32 ( 2021-08-13), p. e26892-
    Details
    In: Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 100, No. 32 ( 2021-08-13), p. e26892-
    Abstract: There was no previous report on the prognostic impact of new-onset or improved anemia after discharge from acute decompensated heart failure (ADHF). We analyzed 771 patients with ADHF and who were followed in multicenters in Japan was divided into 4 groups based on the hemoglobin values at discharge and 6-month index visit: 373 patients (48.4%) with persistent anemia, 87 patients (11.3%) with new-onset anemia, 91 patients (11.8%) with improved anemia, and 220 patients (28.5%) without anemia. The primary outcome measure was a composite of all-cause death or HF hospitalization after index visit. The cumulative 6-month incidences of the primary outcome measure were 25.2% for persistent anemia, 18.5% for new onset anemia, 9.0% for improved anemia, and 9.2% for no anemia (log-rank P   〈  .001). Compared with the no anemia group, the excess risk for the primary outcome measure remained significant in the persistent anemia group [hazard ratio (HR) 2.70, 95% confidence interval (95% CI), 1.45–5.44, P  = .001] and in the new-onset anemia group (HR 2.73, 95% CI 1.19–6.25, P  = .02), while it was not significant in the improved anemia group (HR 1.69, 95% CI 0.68–4.03, P  = .25). Persistent and new-onset anemia at 6-month visit were associated with a subsequent higher risk for all-cause death or HF hospitalization in patients with ADHF, suggesting the importance of detecting anemia during follow-up.
    Type of Medium: Online Resource
    ISSN: 0025-7974 , 1536-5964
    URL: Article
    DOI: 10.1097/MD.0000000000026892
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 9
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    Abstract 15543: Association Between Body Mass Index and Prognosis of Patients Hospitalized With Heart Failure
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Background: The prognostic implications of very low body mass index (BMI) values remain unclear in patients with acute decompensated heart failure (ADHF). This study aimed to investigate the prognostic impact of BMI classification based on the World Health Organization criteria in patients with ADHF. Methods and Results: Using data from 4056 consecutive patients with ADHF hospitalized in 19 participating hospitals in Japan between October 2014 and March 2016, we analyzed 3509 patients with available BMI data at discharge. The patients were divided into five groups; (1) Severely underweight: BMI 〈 16 kg/m 2 , (2) Underweight: BMI≥16 kg/m 2 and 〈 18.5 kg/m 2 , (3) Normal weight: BMI≥18.5 kg/m 2 and 〈 25 kg/m 2 , (4) Overweight: BMI≥25 kg/m 2 and 〈 30 kg/m 2 (5) Obese: BMI≥30 kg/m 2 . The primary outcome measure was all-cause death. The median follow-up duration was 471 days, with 96.4% follow up at 1-year. The cumulative 1-year incidence of all-cause death was higher in underweight groups, and lower in overweight groups (Severely underweight: 36.3%, Underweight: 23.9%, Normal weight: 14.4%, Overweight: 7.9%, and Obese: 9.0%, P 〈 0.001). After adjusting confounders, the excess mortality risk remained significant in the severely underweight group (HR, 2.38; 95%CI, 1.88-3.02; P 〈 0.001), and in the underweight group (HR, 1.33; 95%CI, 1.10-1.62; P=0.003) relative to the normal weight group, while the lower mortality risk was no longer significant in the overweight group (HR, 0.76; 95%CI, 0.57-1.01; P=0.06), and in the obese group (HR, 0.89; 95%CI, 0.53-1.50; P=0.66). Conclusions: Lower BMI, not obesity, was associated with a higher risk for all-cause death after discharge in patients with ADHF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.15543
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 10
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    Association between body mass index and prognosis of patients hospitalized with heart failure
    Springer Science and Business Media LLC ; 2020
    In:  Scientific Reports Vol. 10, No. 1 ( 2020-10-07)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2020-10-07)
    Abstract: The prognostic implications of very low body mass index (BMI) values remain unclear in patients with acute decompensated heart failure (ADHF). This study aimed to investigate the prognostic impact of BMI classification based on the World Health Organization criteria in patients with ADHF. Among 3509 patients with ADHF and available BMI data at discharge in 19 participating hospitals in Japan between October 2014 and March 2016, the study population was divided into five groups; (1) Severely underweight: BMI  〈  16 kg/m 2 , (2) Underweight: BMI ≥ 16 kg/m 2 and  〈  18.5 kg/m 2 , (3) Normal weight: BMI ≥ 18.5 kg/m 2 and  〈  25 kg/m 2 , (4) Overweight: BMI ≥ 25 kg/m 2 and  〈  30 kg/m 2 (5) Obese: BMI ≥ 30 kg/m 2 . The primary outcome measure was all-cause death. The median follow-up duration was 471 days, with 96.4% follow up at 1-year. The cumulative 1-year incidence of all-cause death was higher in underweight groups, and lower in overweight groups (Severely underweight: 36.3%, Underweight: 23.9%, Normal weight: 14.4%, Overweight: 7.9%, and Obese: 9.0%, P   〈  0.001). After adjusting confounders, the excess mortality risk remained significant in the severely underweight group (HR, 2.32; 95%CI, 1.83–2.94; P   〈  0.001), and in the underweight group (HR, 1.31; 95%CI, 1.08–1.59; P  = 0.005) relative to the normal weight group, while the lower mortality risk was no longer significant in the overweight group (HR, 0.82; 95%CI, 0.62–1.10; P  = 0.18) and in the obese group (HR, 1.09; 95%CI, 0.65–1.85; P  = 0.74). Very low BMI was associated with a higher risk for one-year mortality after discharge in patients with ADHF.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-020-73640-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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