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Background: No clinical studies have focused on the factors associated with discharge destination in patients with acute decompensated heart failure. Methods and Results: Of 4,056 consecutive patients hospitalized for ADHF in the KCHF registry, we analyzed 3,460 patients hospitalized from their homes and discharged alive. There were 3009 and 451 patients who were discharged to home (home discharge) and non-home (non-home discharge), respectively. We investigated the factors associated with non-home discharge and compared the outcomes between home discharge and non-home discharge. Factors independently and positively associated with non-home discharge were age ≥80 years (odds ratio [OR]:1.76, 95% confidence interval [CI]:1.28-2.42), body mass index ≤22 kg/m 2 (OR:1.49, 95%CI:1.12-1.97), poor medication adherence (OR:2.08,95%CI:1.49-2.88), worsening heart failure (OR:2.02, 95%CI:1.46-2.82), stroke during hospitalization (OR:3.74, 95%CI:1.75-8.00), functional decline (OR:12.24, 95%CI:8.74-17.14) and length of hospital stay >16 days (OR:4.14, 95%CI:3.01-5.69), while those negatively associated were diabetes mellitus (OR:0.69, 95%CI:0.51-0.94), cohabitants (OR:0.62, 95%CI:0.46-0.85), and ambulatory state before admission (OR:0.25, 95%CI:0.18-0.36). The cumulative 1-year incidence of all-cause death was significantly higher in the non-home discharge group than in the home discharge group. The non-home discharge group compared with the home discharge group was associated with a higher adjusted risk for all-cause death (HR:1.66, P Conclusions: The discharge destination of acute decompensated heart failure patients is influenced by factors such as pre-hospital social background, age, body mass index, low self-care ability, events during hospitalization (worsening heart failure, stroke, etc.), functional decline, and length of hospital stay; moreover, the prognosis of non-home discharge patients is worse than that of home discharge patients.

Background: The prognostic implications of very low body mass index (BMI) values remain unclear in patients with acute decompensated heart failure (ADHF). This study aimed to investigate the prognostic impact of BMI classification based on the World Health Organization criteria in patients with ADHF. Methods and Results: Using data from 4056 consecutive patients with ADHF hospitalized in 19 participating hospitals in Japan between October 2014 and March 2016, we analyzed 3509 patients with available BMI data at discharge. The patients were divided into five groups; (1) Severely underweight: BMI2 , (2) Underweight: BMI≥16 kg/m 2 and 2 , (3) Normal weight: BMI≥18.5 kg/m 2 and 2 , (4) Overweight: BMI≥25 kg/m 2 and 2 (5) Obese: BMI≥30 kg/m 2 . The primary outcome measure was all-cause death. The median follow-up duration was 471 days, with 96.4% follow up at 1-year. The cumulative 1-year incidence of all-cause death was higher in underweight groups, and lower in overweight groups (Severely underweight: 36.3%, Underweight: 23.9%, Normal weight: 14.4%, Overweight: 7.9%, and Obese: 9.0%, P Conclusions: Lower BMI, not obesity, was associated with a higher risk for all-cause death after discharge in patients with ADHF.

Background: The dual antiplatelet therapy (DAPT) score was developed to estimate ischemic and bleeding risks from the DAPT study. However, few studies validated its utility externally. We sought to validate the utility of the DAPT score in the Japanese population. Methods: In a pooled cohort of 3 studies conducted in Japan (the CREDO-Kyoto [Coronary Revascularization Demonstrating Outcome Study in Kyoto] Registry Cohort-2, RESET [Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial], and NEXT [NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial]), we compared risks for ischemic and bleeding events from 13 to 36 months after percutaneous coronary intervention among patients with a DAPT score ≥2 (high DS) and a DAPT score Results: Among 12 223 patients receiving drug-eluting stents who were free from ischemic or bleeding events at 13 months after percutaneous coronary intervention, 3944 patients had high DS and 8279 had low DS. The cumulative incidence of primary ischemic end point (myocardial infarction/stent thrombosis) was significantly higher in high DS than in low DS (1.5% versus 0.9%, P =0.002), whereas the cumulative incidence of primary bleeding end point (GUSTO moderate/severe) tended to be lower in high DS than in low DS (2.1% versus 2.7%, P =0.07). The cumulative incidences of cardiac death, myocardial infarction, and stent thrombosis were also significantly higher in high DS than in low DS (2.0% versus 1.4%, P =0.03; 1.5% versus 0.8%, P =0.002; 0.7% versus 0.3%, P P P =0.03, respectively). Conclusions: In the current population, the DAPT score successfully stratified ischemic and bleeding risks, although the ischemic event rate was remarkably low even in high DS. Further studies would be warranted to evaluate the utility of prolonged DAPT guided by the DAPT score.