Current Status of Cardiovascular Medicine in the Aging Society of Japan
2018; Lippincott Williams & Wilkins; Volume: 138; Issue: 10 Linguagem: Inglês
10.1161/circulationaha.118.035858
ISSN1524-4539
AutoresSatoshi Yasuda, Yoshihiro Miyamoto, Hisao Ogawa,
Tópico(s)Frailty in Older Adults
ResumoHomeCirculationVol. 138, No. 10Current Status of Cardiovascular Medicine in the Aging Society of Japan Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBCurrent Status of Cardiovascular Medicine in the Aging Society of Japan Satoshi Yasuda, MD, PhD, Yoshihiro Miyamoto, MD, PhD and Hisao Ogawa, MD, PhD Satoshi YasudaSatoshi Yasuda National Cerebral and Cardiovascular Center, Suita, Japan. Search for more papers by this author , Yoshihiro MiyamotoYoshihiro Miyamoto National Cerebral and Cardiovascular Center, Suita, Japan. Search for more papers by this author and Hisao OgawaHisao Ogawa Hisao Ogawa, MD, PhD, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-Dai, Suita, Osaka 565–8565, Japan. Email E-mail Address: [email protected] National Cerebral and Cardiovascular Center, Suita, Japan. Search for more papers by this author Originally published4 Sep 2018https://doi.org/10.1161/CIRCULATIONAHA.118.035858Circulation. 2018;138:965–967The face of cardiovascular disease in Japan is largely determined by the increasing longevity of the Japanese population; over the past 50 years, the percentage of the population that is elderly (≥65 years of age) has increased 4-fold, from 5.7% in 1960 to 23.1% in 2010.1 This rate of change is the fastest worldwide. According to the Ministry of Health, Labor, and Welfare of Japan, life expectancy at birth in 2016 was approximately 80.8 years for men and 87.1 years for women. In 2010, cardiovascular diseases (CVDs) accounted for 25.5% of mortality in the Japanese population (total 1.3 billion; men/women 49%/51%).2 In 2014, the percentage of GDP allocated for health care was 8.33% and the proportion of that dedicated to cardiovascular care was 18.9%.The Japanese Registry of All Cardiac and Vascular Diseases (JROAD) was launched in 2004 by the Japanese Circulation Society to assess the clinical activity at each healthcare institution with beds dedicated to patients with CVD. All participating (associated) training hospitals provide real-world, nationwide, primary data as part of an annual survey, including resources (hospitals, beds, and cardiologists), burden (number of inpatients), and outcomes (cardiovascular mortality and autopsy).3The Table shows the changes in the number of patients with acute myocardial infarction (AMI) and heart failure (HF) hospitalized during the past 5 years (2012–2016). The response rate of participating training hospitals was 100% each year (n=1298–1343 hospitals). HF was diagnosed by cardiologists on the basis of the Framingham clinical criteria. The number of patients with AMI hospitalized per year was ≈69 000 in 2012, increasing slightly to ≈73 000 in 2016. Inhospital mortality from AMI was ≈8%. It is important to note that the number of patients with HF hospitalized per year was ≈210 000 in 2012, increasing progressively to ≈260 000 in 2016. Inhospital mortality from HF was ≈8%. The JROAD started to collect 2015 data on acute aortic dissection, a catastrophic clinical entity. The number of patients hospitalized for acute aortic dissection was 20 406 in 2015 and 22 171 in 2016, and inhospital mortality was 10.8% and 11.5%, respectively. The number of Japanese Circulation Society board-certified cardiologists increased from 12 441 at 2012 to 13 690 at 2016.Table. Annual Survey Data of the Japanese Registry of All Cardiac and Vascular Diseases (JROAD), 2012–2016Year20122013201420152016No. of patients with acute myocardial infarction hospitalized69 23467 91868 85071 80373 421Inhospital mortality from acute myocardial infarction (%)8.18.68.48.28.4No. of patients with heart failure hospitalized212 793229 417238 840247 996260 157Inhospital mortality from heart failure (%)8.38.37.87.97.9No. of patients with acute aortic dissection hospitalized———20 40622 171Inhospital mortality from acute aortic dissection (%)———10.811.4No. of beds in institutes participating in the Japanese Registry of All Cardiac and Vascular Diseases558 992545 042537 898548 690551 539No. certified by Japanese Circulation Society Cardiologists12 44112 77713 14213 42413 690 Training hospitals993100599810041017 Associated training hospitals305320323331336In 2014, in collaboration with National Cerebral and Cardiovascular Center, the Japanese Circulation Society began developing the JROAD-Diagnosis Procedure Combination (DPC) database, which is derived from the Japanese DPC/Per Diem Payment System (PDPS). The DPC/PDPS database includes the following information on each patient: unique hospital identifier, age and sex, main diagnoses and comorbidities, drugs and devices, diagnostic and therapeutic procedures, length of stay, and discharge status.4 The JROAD-DPC database includes data from 610 certified hospitals of 704 593 health records of patients hospitalized between April 1, 2012, and March 31, 2013.3 Data on 35 824 patients with AMI and 108 665 patients with HF were extracted based on International Statistical Classification of Diseases and Related Health Problems 10 codes. The mean length of hospital stay was 16.8 days for AMI and 23.1 days for HF, respectively.The JROAD-DPC database for AMI consists of 25 788 male (72.0%) and 10 036 female (28.0%) hospitalized patients. The peak age groups were 60 to 69 years in men and 80 to 89 years in women. The average ages of the male and female patients with AMI were 67±13 and 77±13 years, respectively. Although little variation occurred among patients with AMI in terms of aspirin use at discharge (median prescription rate, 83.0%; interquartile range [IQR], 76.9%–88.0%), there were wide variations in the proportions of patients prescribed β-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at discharge (41.4%, IQR 27.6%–55.7% and 52.0%, IQR 40.3%–62.3%, respectively). The JROAD-DPC database for HF consists of 57 368 male (52.8%) and 51 297 female (47.2%) hospitalized patients. The peak age was 80 to 89 years in both men and women. The average ages of the male and female patients with HF were 75±13 and 81±12 years, respectively. In patients with HF, there were between-hospital variations in medications at discharge (β-blockers, 38.1%; IQR, 27.8%–47.6%; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, 41.0%; IQR, 31.7%–49.1%).Assessments of the process of care play an important role in the management of CVD and are targets of hospital quality improvement initiatives, as reported in the American Heart Association’s Get With the Guidelines program. Also, there is a substantial need for new drug and device therapies for CVD. In Japan, the Pharmaceutical and Medical Devices Agency has conducted consultations concerning the clinical trials of new drugs and medical devices, as well as approval reviews and surveys of the reliability of application data. Staffed by Japanese and US cardiovascular specialists, the Ministry of Health, Labor, and Welfare/Pharmaceutical and Medical Devices Agency and US Food and Drug Administration collaboration, termed the Harmonization by Doing initiative, has been operating since 2003.5In older adults, the number and complexity of comorbid conditions commonly increase, and therefore concepts regarding CVD in combination with multimorbidity are emerging. The prevalence of multimorbidity (ie, both cerebral and CVD) was 9.8% (145 070 of 1 484 555 patients) in the recent 3-year JROAD-DPC data. The urgency of the problem of CVD and stroke burden and the adverse consequences are being recognized. Currently, in cooperation with the Japan Stroke Society, the Japanese Circulation Society promotes “The Five-Year Plan for Overcoming Cardiovascular Disease,” which addresses 5 strategies: human resource development, improvement in healthcare systems, education regarding disease prevention and people, promotion of registration undertaking (eg, JROAD), and strengthening of basic and clinical research. The aim of this plan is to improve the medical care for CVD in an era of increasing prevalence of stroke and CVD. The goals of this plan are “5% reduction of age-matched mortality rate by the next 5 years, and extension of healthy life expectancy.”6In conclusion, comprehensive information about CVD in Japan, with its rapidly aging population, will be crucial for developing future perspectives in this and other countries.DisclosuresDr Yasuda reports remuneration for lectures from Bristol-Myers Squibb, Daiichi Sankyo, and Takeda, and trust research/joint research funds from Daiichi Sankyo and Takeda. The other authors report no conflicts of interest.Footnoteshttps://www.ahajournals.org/journal/circHisao Ogawa, MD, PhD, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-Dai, Suita, Osaka 565–8565, Japan. Email [email protected]go.jpReferences1. Ministry of Health, Labour and Welfare. Statistics.2015. http://www.mhlw.go.jp/toukei_hakusho/toukei/index.html. Accessed July 30, 2018.Google Scholar2. Ministry of Health, Labour and Welfare. The Ministry of Health Population Movement Statistics.2010. http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/kakutei10/.Google Scholar3. Yasuda S, Nakao K, Nishimura K, Miyamoto Y, Sumita Y, Shishido T, Anzai T, Tsutsui H, Ito H, Komuro I, Saito Y, Ogawa H; on behalf of JROAD Investigators. The current status of cardiovascular medicine in Japan: analysis of a large number of health records from a nationwide claim-based database, JROAD-DPC.Circ J. 2016; 80:2327–2335. doi: 10.1253/circj.CJ-16-0196CrossrefMedlineGoogle Scholar4. Yasunaga H, Ide H, Imamura T, Ohe K. Impact of the Japanese diagnosis procedure combination-based payment system on cardiovascular medicine-related costs.Int Heart J. 2005; 46:855–866.CrossrefMedlineGoogle Scholar5. Murakami M, Suzuki Y, Tominaga T. Rapid globalization of medical device clinical development programs in Japan: the case of drug-eluting stents.Circ J. 2018; 82:636–643. doi: 10.1253/circj.CJ-17-0533CrossrefMedlineGoogle Scholar6. Japanese Circulation Society.http://www.jcirc.or.jp/english/about/riji.html. Accessed July 30, 2018.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited ByKanaoka K, Onoue K, Terasaki S, Nakano T, Nakai M, Sumita Y, Hatakeyama K, Terasaki F, Kawakami R, Iwanaga Y, Miyamoto Y, Saito Y, Yuda S, Tanno M, Takahashi T, Yokoshiki H, Toba M, Anzai T, Nagai T, Sato T, Takenaka T, Yamazaki S, Katagiri Y, Takeuchi T, Sugitatsu K, Kakinoki S, Matsumoto T, Urasawa K, Tan M, Tsujino I, Kamigaki M, Tomita H, Hanada K, Kushibiki M, Nakamura A, Morino Y, Nasu T, Yasuda S, Suzuki H, Iwabuchi K, Tsuji K, Namiuchi S, Komaru T, Yagi M, Uematsu S, Takahashi T, Takeda S, Nakanishi T, Watanabe M, Wanezaki M, Matsui M, Sugawara S, Takeishi Y, Oikawa M, Komatsu N, Suzuki S, Okamoto H, Takeyasu N, Akiyama D, Eki Y, Kakuta T, Sugiyama T, Koizumi T, Ueno K, Kario K, Taki M, Matsumoto Y, Yasu T, Nishioka O, Naito S, Murata M, Tange S, Kaneko K, Muto M, Inagaki H, Hasegawa S, Tachibana E, Atsumi W, Suzuki M, Muramatsu T, Yamada Y, Taguchi I, Fukuda Y, Matsui A, Kanda J, Hozawa K, Matsumura A, Shimizu W, Yamamoto T, Komuro I, Hatano M, Ikeda T, Kiuchi S, Chikamori T, Takei Y, Soejima K, Minamishima T, Tanaka H, Shimizu S, Kasao M, Kadohira T, Minamino T, Shimada K, Iwata H, Momiyama Y, Ashikaga T, Nozato T, Fujiwara Y, Inoue K, Sasano T, Matsuda J, Ishii Y, Ono Y, Tanabe K, Horiuchi Y, Shinke T, Kodama Y, Moroi M, Yazaki Y, Mizumura T, Ohta H, Akashi Y, Kotoku N, Ikari Y, Maruyama M, Sato Y, Tamura K, Konishi M, Suzuki H, Ebato M, Fukui K, Yumoto K, Iwasawa T, Kashimura T, Takahashi K, Okada Y, Kaku B, Usuda K, Maruyama M, Kameyama T, Higashikata T, Hodatsu A, Osato K, Nagata Y, Maeno K, Satake K, Sawanobori T, Watanabe N, Kuwahara K, Motoki H, Kitabayashi H, Otagiri K, Kono T, Yamagishi D, Yazaki Y, Noda T, Morishima I, Watanabe N, Tanaka S, Onodera T, Nawada R, Watanabe A, Matsunaga M, Suwa S, Sakamoto H, Sakamoto H, Aoyama T, Kanamori N, Muto M, Maekawa Y, Ohtani H, Ozaki Y, Naruse K, Takemoto K, Kamiya H, Suzuki T, Tomita Y, Suzuki S, Kametani R, Aoyama H, Osanai H, Harada K, Kada K, Saeki T, Kobayashi K, Ogawa Y, Terasawa A, Shinoda M, Oguri M, Shimizu K, Sawamura A, Sugiura A, Hattori K, Mokuno S, Kondo K, Dohi K, Moriwaki K, Kasai A, Nakakuki T, Kaitani K, Jinnai T, Yamamoto T, Kurata H, Wada A, Akao M, Hamatani Y, Ishibashi K, Akakabe Y, Asaumi Y, Matama H, Sakata Y, Kioka H, Takaishi H, Iwanaga Y, Takase T, Matsuda M, Sato F, Hasegawa S, Ishigami K, Ichikawa M, Takagi T, Inoko M, Hoshiga M, Fujita S, Takeda Y, Kawarabayashi T, Takaoka H, Nakajima K, Yuguchi T, Kawasaki T, Shinoda Y, Sato Y, Ishihara M, Matsumoto Y, Kawai H, Takaya T, Matsuo K, Mano T, Hirata K, Hisamatsu E, Inoue N, Tamita K, Mukohara N, Shimoyama H, Miyajima T, Tamura T, Tamaki Y, Suzuki M, Yokota R, Horii M, Yamanaka K, Kawata H, Hashimoto Y, Nakada Y, Nakagawa H, Ueda T, Nishida T, Seno A, Watanabe M, Akasaka T, Tanimoto T, Toyofuku M, Yamamoto K, Kinugasa Y, Hirai M, Nasu H, Shirota K, Oda T, Oka T, Kadota K, Ohya M, Ito H, Nakamura K, Ogura S, Fuke S, Uemura S, Matsubara H, Watanabe A, Morishima N, Kihara Y, Hidaka T, Ueda H, Ono Y, Muraoka Y, Hatanari M, Miyamoto Y, Dote K, Kato M, Yano M, Mochizuki M, Ikeda Y, Fujinaga H, Hosokawa S, Sata M, Yamaguchi K, Aki N, Minamino T, Miyake Y, Takagi Y, Doi M, Taketani Y, Okayama H, Shigematsu T, Higaki A, Yamaguchi O, Inaba S, Ikeda S, Kawai K, Kitaoka H, Kubo T, Ando K, Inui K, Fukumoto Y, Hori K, Homma T, Kawasaki T, Mohri M, Fujiwara M, Tsutsui H, Ide T, Miura S, Kuwano T, Shimomura H, Kadokami T, Taba M, Kondou K, Kubota T, Nagatomo D, Mukai Y, Matsukawa R, Tashiro H, Shimomura M, Maemura K, Kawano H, Oku K, Yamasa T, Kizaki Y, Sakamoto T, Tamura Y, Ito T, Fujimoto K, Tsujita K, Takashio S, Kurokawa H, Takahashi N, Saito S, Arikawa M, Shibata Y, Nishihira K, Tsuruda T, Sonoda M, Atsuchi N, Ohishi M, Higuchi K, Miyata M, Oketani N, Akimoto Y, Asahi T and Wake M (2022) Features and Outcomes of Histologically Proven Myocarditis With Fulminant Presentation, Circulation, 146:19, (1425-1433), Online publication date: 8-Nov-2022. 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