Hospitalization for Heart Failure in the United States, UK, Taiwan, and Japan: An International Comparison of Administrative Health Records on 413,385 Individual Patients
Hospitalization for Heart Failure in the United States, UK, Taiwan, and Japan: An International Comparison of Administrative Health Records on 413,385 Individual Patients
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DOI：
10.1016/j.cardfail.2021.08.024
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发表时间：
2022-03-09
影响因子：
6
通讯作者：
Quint, Jennifer K.
中科院分区：
文献类型：
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作者：
Sundaram, Varun;Nagai, Toshiyuki;Quint, Jennifer K.
背景：登记显示心力衰竭(HF)患者的特征和结果在国际上存在差异，但国家样本很少大，而且由于学术中心的登记，病例选择可能存在偏见。国家行政数据集提供了大样本，偏倚风险较低。本研究利用美国、英国、台湾、日本等3大洲4个高收入国家的电子健康档案，比较3大洲4个高收入国家(美国、英国、台湾、日本)初次心力衰竭住院患者的特征、医疗资源利用(Hru)及转归。方法与结果：2012-2014年间，我们利用电子健康档案识别计划外的心力衰竭。我们确定了分别来自美国、英国、台湾和日本的231,512，10,991，36,900和133,982名原发性高血压患者。每10万人的HFH在美国最高，在台湾最低。在台湾和日本，肥胖或患有慢性肾脏疾病的患者较少。住院时间在美国最短(中位数4天)，在英国、台湾和日本较长(中位数分别为7、9和17天)。住院期间Hru以日本最高，英国最低。美国的粗标化率和直接标化住院死亡率最低(直接标化率1.8，95%可信区间1.7%-1.9%)，台湾(直接标化率3.9，95%可信区间3.8%-4.1%)、英国(直接标化率6.4，95%可信区间6.1%-6.7%)和日本(直接标化率6.7，95%可信区间6.6%-6.8%)依次升高。30天的全原因再入院率(25.8%)和心力衰竭再入院率(7.2%)在美国最高，在日本最低(分别为11.9%和5.1%)。结论：患者特征、Hru和临床结果存在显著的国际差异；了解这些差异可能会为卫生保健政策和国际试验设计提供参考。
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.Y