Clinical Characteristics and Outcomes of Heart Failure Patients With Long-Term Care Insurance ― Insights From the Kitakawachi Clinical Background and Outcome of Heart Failure Registry ―

Kensuke Takabayashi, Kotaro Iwatsu, Tsutomu Ikeda, Yuko Morikami, Tahei Ichinohe, Takashi Yamamoto, Kotoe Takenaka, Hiroyuki Takenaka, Hiroyuki Muranaka, Ryoko Fujita, Miyuki Okuda, Osamu Nakajima, Hitoshi Koito, Yuka Terasaki, Tetsuhisa Kitamura, Shouji Kitaguchi, Ryuji Nohara, Clinical Characteristics and Outcomes of Heart Failure Patients With Long-Term Care Insurance ― Insights From the Kitakawachi Clinical Background and Outcome of Heart Failure Registry ―, Circulation Journal, 2020, Volume 84, Issue 9, Pages 1528-1535, Released August 25, 2020, [Advance publication] Released July 21, 2020, Online ISSN 1347-4820, Print ISSN 1346-9843, https://doi.org/10.1253/circj.CJ-20-0017, https://www.jstage.jst.go.jp/article/circj/84/9/84_CJ-20-0017/_article/-char/en
Background: In Japan, the long-term care insurance (LTCI) system has an important role in helping elderly people, but there have been no clinical studies that have examined the relationship between the LTCI and prognosis for patients with acute heart failure (HF). Methods and Results: This registry was a prospective multicenter cohort, 1,253 patients were enrolled and 965 patients with acute HF aged ≥65 years were comprised the study group. The composite endpoint included all-cause death and hospitalization for HF after discharge. We divided the patients into 4 groups: (i) patients without LTCI, (ii) patients requiring support level 1 or 2, (iii) patients with care level 1 or 2, and (iv) patients with care levels 3-5. The Kaplan-Meier analysis identified a lower rate of the composite endpoint in group (i) than in the other groups. After adjusting for potentially confounding effects using a Cox proportional regression model, the hazard ratio (HR) of the composite endpoint increased significantly in groups (iii) and (iv) (adjusted HR, 1.62; 95% confidence interval [CI], 1.22-1.98 and adjusted HR, 1.62; 95% CI, 1.23-2.14, respectively) when compared with group (i). However, there was no significant difference between groups (i) and (ii). Conclusions: The level of LTCI was associated with a higher risk of the composite endpoint after discharge in acute HF patients.