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Hospitalization for Heart Failure in the United States, UK, Taiwan, and Japan: An International Comparison of Administrative Health Records on 413,385 Individual Patients

      Highlights

      • Previous reports evaluating international differences in characteristics and survival of patients hospitalized for heart failure are mainly from clinical trials and registries with small national samples and biased case-selection.
      • This study of nationally representative electronic health care records of more than 400,000 patients hospitalized for heart failure from 4 countries on 3 continents reveals marked variations in patient characteristics, health care resource use, and clinical outcomes.
      • A better understanding of these international variations may help in the translation of health care interventions from one country to another and in the design of international trials.

      Abstract

      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.

      Graphical Abstract

      Key Words

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      Linked Article

      • Globe is Still Heterogenous from the Perspective of Heart Failure
        Journal of Cardiac FailureVol. 28Issue 3
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          In an era of an increasing number of patients with heart failure (HF) patients and increasing economic burden, mainly owing to HF readmissions worldwide, international collaboration studies focusing on patients hospitalized for HF and clinical outcomes are extremely important, which provides new insights into transitional care from hospital to home in the context of HF management in each country. In this issue of the Journal Sundaram et al,1 have reported marked variations in characteristics of the patients with HF, health care resource use and clinical outcomes using nationally representative electronic health care records on 413,385 patients from the United States, the UK, Taiwan, and Japan.
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