Regional Disparities in Adherence to Guidelines for the Treatment of Chronic Heart Failure

• Published in: Internal Medicine Vol. 60; no. 4; pp. 525 - 532
• Main Authors: Matsuo, Yuji, Yoshimine, Fumitoshi, Fuse, Katsuya, Suzuki, Kazuo, Sakamoto, Takuya, Iijima, Kenichi, Ozaki, Kazuyuki, Minamino, Tohru
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.02.2021; Japan Science and Technology Agency
• Subjects: Angiotensin; Angiotensin II; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Beta blockers; Cardiomyopathy; Congestive heart failure; Defibrillators; Echocardiography; Ejection fraction; Fibrillation; guidelines; Heart failure; Heart Failure - therapy; Humans; Internal medicine; Japan - epidemiology; Myocardial infarction; Original; Patients; Peptidyl-dipeptidase A; regional disparity; Rehabilitation; Rural areas; Stroke Volume; Ventricle; Ventricular Function, Left; Japan; heart failure; guidelines; regional disparity
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.4660-20

Objective The incidence of chronic heart failure (CHF) is likely to keep increasing in Japan as the population ages, placing increased burdens on medical facilities, particularly on the limited numbers of rural hospitals. We explored the appropriateness of CHF treatment in rural areas in Japan. Methods We compared rates of adherence to therapeutic guidelines for CHF between residents with a left ventricular ejection fraction <35% living in urban areas (n = 207) and those in rural areas (n = 180). Treatments included pharmacological [beta-blockers, angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blocker (ARB), mineralocorticoid receptor antagonist (MRA) and anticoagulants for atrial fibrillation] and non-pharmacological [implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT), cardiac rehabilitation and HF education] approaches. Patients This study included 387 patients with CHF, prior myocardial infarction or cardiomyopathy, and a left ventricular ejection fraction (LVEF) <35% as determined by echocardiography. Results The respective rates of treatments administered in urban and rural areas were as follows: beta-blockers, 91.3% vs. 61.7% (p<0.05); ACEi/ARB, 86.5% vs. 68.3% (p<0.05); MRA, 74.4% vs. 59.4% (p<0.01); anticoagulants, 100% vs. 86.5%, (p<0.05); ICD/CRT, 45.4% vs. 5.0% (p<0.05); cardiac rehabilitation, 32.4% vs. 13.3% (p<0.05) and HF education, 33.3% vs. 32.8% (p=0.75). Conclusion Regional disparities in treatment for CHF persist, even in Japan. Improvements in the use of guideline-directed treatment in rural areas might improve the outcomes for CHF patients.