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Outcome of hospitalised heart failure in Japan and the United Kingdom stratified by plasma N-terminal pro-B-type natriuretic peptide

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Abstract

Background

Mortality subsequent to a hospitalisation for heart failure is reported to be much lower in Japan than in the United Kingdom (UK). This could reflect differences in disease severity or in management. Accordingly, we directly compared patient backgrounds and outcomes between Japan and UK.

Methods

Consecutive patients admitted to academic hospitals in the UK and Japan with heart failure had a common set of variables, including plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP), collected during admission. Mortality during hospitalisations, at 90 and 180 days was recorded and stratified by quintile of NT-proBNP.

Results

Overall, 935 patients were enrolled; 197 from UK and 738 from Japan. Median (interquartile range) age [UK: 78 (71–88) vs. Japan: 78 (70–84) years; p = 0.947], glomerular filtration rate [UK: 49 (34–68) vs. Japan: 49 (33–65) ml/min/1.73 m2; p = 0.209] and plasma NT-proBNP [UK: 4957 (2278–10,977) vs. Japan: 4155 (1972–9623) ng/l; p = 0.186] were similar, but systolic blood pressure was lower in the UK [118 (105–131) vs. 137 (118–159) mmHg; p < 0.001]. Patients with a higher plasma NT-proBNP had a worse prognosis in both countries; in-hospital and post-discharge mortality rates were higher in the UK even after adjusting for prognostic variables including NT-proBNP.

Conclusions

This analysis suggests that either unobserved differences in patient characteristics or differences in care (formal or informal) rather than greater heart failure severity may account for the worse outcome of heart failure in the UK compared to Japan.

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Acknowledgements

We thank Dr. Benjamin Dicken, and other staffs of the WET-HF and Hull Lifelab registries for their important contributions.

Funding

This research was supported by a Grant from the Ministry of Education, Culture, Sports, Science, and Technology, Japan (KAKENHI no. 21790751) and Butterfield Awards for UK-Japan collaboration in Medicine & Health.

Author information

Authors and Affiliations

  1. Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan

    Yasuyuki Shiraishi, Shun Kohsaka, Takashi Kohno & Keiichi Fukuda

  2. National Heart and Lung Institute, Imperial College, London, UK

    Toshiyuki Nagai

  3. Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Toshiyuki Nagai

  4. Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan

    Ayumi Goda

  5. Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan

    Yuji Nagatomo & Tsutomu Yoshikawa

  6. Department of Cardiology, St. Luke’s International Hospital, Tokyo, Japan

    Atsushi Mizuno

  7. Academic Cardiology, Castle Hill Hospital, Kingston-upon-Hull, UK

    Alan Rigby

  8. Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK

    Andrew L. Clark & John G. F. Cleland

  9. Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK

    John G. F. Cleland

  10. National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK

    John G. F. Cleland

Authors
  1. Yasuyuki Shiraishi
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  2. Toshiyuki Nagai
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  3. Shun Kohsaka
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  9. Keiichi Fukuda
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  10. Tsutomu Yoshikawa
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  11. Andrew L. Clark
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Corresponding author

Correspondence to Shun Kohsaka.

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Conflict of interest

Dr. Kohsaka received an unrestricted research grant for the Department of Cardiology, Keio University School of Medicine from Bayer Pharmaceutical Co., Ltd and Daiichi Sankyo Co. Ltd. Dr. Nagai is supported by grants from the Daiichi Sankyo Foundation of Life Science and the Mochida Memorial Foundation for Medical and Pharmaceutical Research. Dr. Cleland acknowledges support from Amgen, Novartis, Medtronic, and Servier. Other authors have no conflicts of interest to disclose. There are no patents, products in development, or marketed products to declare.

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Shiraishi, Y., Nagai, T., Kohsaka, S. et al. Outcome of hospitalised heart failure in Japan and the United Kingdom stratified by plasma N-terminal pro-B-type natriuretic peptide. Clin Res Cardiol 107, 1103–1110 (2018). https://doi.org/10.1007/s00392-018-1283-6

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  • DOI: https://doi.org/10.1007/s00392-018-1283-6

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