Public assistance in patients with acute heart failure: a report from the KCHF registry
Abstract Aims There is a scarcity of data on the post‐discharge prognosis in acute heart failure (AHF) patients with a low‐income but receiving public assistance. The study sought to evaluate the differences in the clinical characteristics and outcomes between AHF patients receiving public assistanc...
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| Format: | Article |
| Language: | English |
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Wiley
2022-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13898 |
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| author | Yuji Nishimoto Takao Kato Takeshi Morimoto Ryoji Taniguchi Hidenori Yaku Yasutaka Inuzuka Yodo Tamaki Erika Yamamoto Yusuke Yoshikawa Takeshi Kitai Moritake Iguchi Masashi Kato Mamoru Takahashi Toshikazu Jinnai Tomoyuki Ikeda Kazuya Nagao Takafumi Kawai Akihiro Komasa Ryusuke Nishikawa Yuichi Kawase Takashi Morinaga Kanae Su Mitsunori Kawato Yuta Seko Moriaki Inoko Mamoru Toyofuku Yutaka Furukawa Yoshihisa Nakagawa Kenji Ando Kazushige Kadota Satoshi Shizuta Koh Ono Koichiro Kuwahara Neiko Ozasa Yukihito Sato Takeshi Kimura |
| author_facet | Yuji Nishimoto Takao Kato Takeshi Morimoto Ryoji Taniguchi Hidenori Yaku Yasutaka Inuzuka Yodo Tamaki Erika Yamamoto Yusuke Yoshikawa Takeshi Kitai Moritake Iguchi Masashi Kato Mamoru Takahashi Toshikazu Jinnai Tomoyuki Ikeda Kazuya Nagao Takafumi Kawai Akihiro Komasa Ryusuke Nishikawa Yuichi Kawase Takashi Morinaga Kanae Su Mitsunori Kawato Yuta Seko Moriaki Inoko Mamoru Toyofuku Yutaka Furukawa Yoshihisa Nakagawa Kenji Ando Kazushige Kadota Satoshi Shizuta Koh Ono Koichiro Kuwahara Neiko Ozasa Yukihito Sato Takeshi Kimura |
| author_sort | Yuji Nishimoto |
| collection | DOAJ |
| description | Abstract Aims There is a scarcity of data on the post‐discharge prognosis in acute heart failure (AHF) patients with a low‐income but receiving public assistance. The study sought to evaluate the differences in the clinical characteristics and outcomes between AHF patients receiving public assistance and those not receiving public assistance. Methods and results The Kyoto Congestive Heart Failure registry was a physician‐initiated, prospective, observational, multicentre cohort study enrolling 4056 consecutive patients who were hospitalized due to AHF for the first time between October 2014 and March 2016. The present study population consisted of 3728 patients who were discharged alive from the index AHF hospitalization. We divided the patients into two groups, those receiving public assistance and those not receiving public assistance. After assessing the proportional hazard assumption of public assistance as a variable, we constructed multivariable Cox proportional hazard models to estimate the risk of the public assistance group relative to the no public assistance group. There were 218 patients (5.8%) receiving public assistance and 3510 (94%) not receiving public assistance. Patients in the public assistance group were younger, more frequently had chronic coronary artery disease, previous heart failure hospitalizations, current smoking, poor medical adherence, living alone, no occupation, and a lower left ventricular ejection fraction than those in the no public assistance group. During a median follow‐up of 470 days, the cumulative 1 year incidences of all‐cause death and heart failure hospitalizations after discharge did not differ between the public assistance group and no public assistance group (13.3% vs. 17.4%, P = 0.10, and 28.3% vs. 23.8%, P = 0.25, respectively). After adjusting for the confounders, the risk of the public assistance group relative to the no public assistance group remained insignificant for all‐cause death [hazard ratio (HR), 0.97; 95% confidence interval (CI), 0.69–1.32; P = 0.84]. Even after taking into account the competing risk of all‐cause death, the adjusted risk within 180 days in the public assistance group relative to the no public assistance group remained insignificant for heart failure hospitalizations (HR, 0.93; 95% CI, 0.64–1.34; P = 0.69), while the adjusted risk beyond 180 days was significant (HR, 1.56; 95% CI, 1.07–2.29; P = 0.02). Conclusions The AHF patients receiving public assistance as compared with those not receiving public assistance had no significant excess risk for all‐cause death at 1 year after discharge or a heart failure hospitalization within 180 days after discharge, while they did have a significant excess risk for heart failure hospitalizations beyond 180 days after discharge. 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) |
| format | Article |
| id | doaj-art-083de6817b66453d94b6c88d68c6c18c |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-083de6817b66453d94b6c88d68c6c18c2025-02-05T05:22:10ZengWileyESC Heart Failure2055-58222022-06-01931920193010.1002/ehf2.13898Public assistance in patients with acute heart failure: a report from the KCHF registryYuji Nishimoto0Takao Kato1Takeshi Morimoto2Ryoji Taniguchi3Hidenori Yaku4Yasutaka Inuzuka5Yodo Tamaki6Erika Yamamoto7Yusuke Yoshikawa8Takeshi Kitai9Moritake Iguchi10Masashi Kato11Mamoru Takahashi12Toshikazu Jinnai13Tomoyuki Ikeda14Kazuya Nagao15Takafumi Kawai16Akihiro Komasa17Ryusuke Nishikawa18Yuichi Kawase19Takashi Morinaga20Kanae Su21Mitsunori Kawato22Yuta Seko23Moriaki Inoko24Mamoru Toyofuku25Yutaka Furukawa26Yoshihisa Nakagawa27Kenji Ando28Kazushige Kadota29Satoshi Shizuta30Koh Ono31Koichiro Kuwahara32Neiko Ozasa33Yukihito Sato34Takeshi Kimura35Department of Cardiology Hyogo Prefectural Amagasaki General Medical Center Hyogo JapanDepartment of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Clinical Epidemiology Hyogo College of Medicine Hyogo JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Hyogo JapanDepartment of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Cardiology Shiga Medical Center for Adults Shiga JapanDivision of Cardiology Tenri Hospital Nara JapanDepartment of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka JapanDepartment of Cardiology National Hospital Organization Kyoto Medical Center Kyoto JapanDepartment of Cardiology Mitsubishi Kyoto Hospital Kyoto JapanDepartment of Cardiology Shimabara Hospital Kyoto JapanDepartment of Cardiology Japanese Red Cross Otsu Hospital Shiga JapanDepartment of Cardiology Hikone Municipal Hospital Shiga JapanDepartment of Cardiology Osaka Red Cross Hospital Osaka JapanDepartment of Cardiology Kishiwada City Hospital Osaka JapanDepartment of Cardiology Kansai Electric Power Hospital Osaka JapanDepartment of Cardiology Kurashiki Central Hospital Okayama JapanDepartment of Cardiology Kurashiki Central Hospital Okayama JapanDepartment of Cardiology Kokura Memorial Hospital Fukuoka JapanDepartment of Cardiology Japanese Red Cross Wakayama Medical Center Wakayama JapanDepartment of Cardiology Nishi‐Kobe Medical Center Hyogo JapanCardiovascular Center The Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka JapanCardiovascular Center The Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka JapanDepartment of Cardiology Japanese Red Cross Wakayama Medical Center Wakayama JapanDepartment of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka JapanDivision of Cardiology Tenri Hospital Nara JapanDepartment of Cardiology Kokura Memorial Hospital Fukuoka JapanDepartment of Cardiology Kurashiki Central Hospital Okayama JapanDepartment of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Cardiovascular Medicine Shinshu University Graduate School of Medicine Matsumoto JapanDepartment of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Hyogo JapanDepartment of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto JapanAbstract Aims There is a scarcity of data on the post‐discharge prognosis in acute heart failure (AHF) patients with a low‐income but receiving public assistance. The study sought to evaluate the differences in the clinical characteristics and outcomes between AHF patients receiving public assistance and those not receiving public assistance. Methods and results The Kyoto Congestive Heart Failure registry was a physician‐initiated, prospective, observational, multicentre cohort study enrolling 4056 consecutive patients who were hospitalized due to AHF for the first time between October 2014 and March 2016. The present study population consisted of 3728 patients who were discharged alive from the index AHF hospitalization. We divided the patients into two groups, those receiving public assistance and those not receiving public assistance. After assessing the proportional hazard assumption of public assistance as a variable, we constructed multivariable Cox proportional hazard models to estimate the risk of the public assistance group relative to the no public assistance group. There were 218 patients (5.8%) receiving public assistance and 3510 (94%) not receiving public assistance. Patients in the public assistance group were younger, more frequently had chronic coronary artery disease, previous heart failure hospitalizations, current smoking, poor medical adherence, living alone, no occupation, and a lower left ventricular ejection fraction than those in the no public assistance group. During a median follow‐up of 470 days, the cumulative 1 year incidences of all‐cause death and heart failure hospitalizations after discharge did not differ between the public assistance group and no public assistance group (13.3% vs. 17.4%, P = 0.10, and 28.3% vs. 23.8%, P = 0.25, respectively). After adjusting for the confounders, the risk of the public assistance group relative to the no public assistance group remained insignificant for all‐cause death [hazard ratio (HR), 0.97; 95% confidence interval (CI), 0.69–1.32; P = 0.84]. Even after taking into account the competing risk of all‐cause death, the adjusted risk within 180 days in the public assistance group relative to the no public assistance group remained insignificant for heart failure hospitalizations (HR, 0.93; 95% CI, 0.64–1.34; P = 0.69), while the adjusted risk beyond 180 days was significant (HR, 1.56; 95% CI, 1.07–2.29; P = 0.02). Conclusions The AHF patients receiving public assistance as compared with those not receiving public assistance had no significant excess risk for all‐cause death at 1 year after discharge or a heart failure hospitalization within 180 days after discharge, while they did have a significant excess risk for heart failure hospitalizations beyond 180 days after discharge. 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)https://doi.org/10.1002/ehf2.13898Acute heart failurePublic assistanceMortality |
| spellingShingle | Yuji Nishimoto Takao Kato Takeshi Morimoto Ryoji Taniguchi Hidenori Yaku Yasutaka Inuzuka Yodo Tamaki Erika Yamamoto Yusuke Yoshikawa Takeshi Kitai Moritake Iguchi Masashi Kato Mamoru Takahashi Toshikazu Jinnai Tomoyuki Ikeda Kazuya Nagao Takafumi Kawai Akihiro Komasa Ryusuke Nishikawa Yuichi Kawase Takashi Morinaga Kanae Su Mitsunori Kawato Yuta Seko Moriaki Inoko Mamoru Toyofuku Yutaka Furukawa Yoshihisa Nakagawa Kenji Ando Kazushige Kadota Satoshi Shizuta Koh Ono Koichiro Kuwahara Neiko Ozasa Yukihito Sato Takeshi Kimura Public assistance in patients with acute heart failure: a report from the KCHF registry ESC Heart Failure Acute heart failure Public assistance Mortality |
| title | Public assistance in patients with acute heart failure: a report from the KCHF registry |
| title_full | Public assistance in patients with acute heart failure: a report from the KCHF registry |
| title_fullStr | Public assistance in patients with acute heart failure: a report from the KCHF registry |
| title_full_unstemmed | Public assistance in patients with acute heart failure: a report from the KCHF registry |
| title_short | Public assistance in patients with acute heart failure: a report from the KCHF registry |
| title_sort | public assistance in patients with acute heart failure a report from the kchf registry |
| topic | Acute heart failure Public assistance Mortality |
| url | https://doi.org/10.1002/ehf2.13898 |
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