Quality of Care Improvement in Heart Failure using Patient-reported Outcome

• Project/Area Number: 20K22883
• Research Category: Grant-in-Aid for Research Activity Start-up
• Allocation Type: Multi-year Fund
• Review Section: 0902:General internal medicine and related fields
• Research Institution: Keio University
• Principal Investigator: SHOJI SATOSHI 慶應義塾大学, 医学部(信濃町), 共同研究員 (00875411)
• Project Period (FY): 2020-09-11 – 2022-03-31
• Project Status: Completed (Fiscal Year 2021)
• Budget Amount: ¥2,340,000 (Direct Cost: ¥1,800,000、Indirect Cost: ¥540,000); Fiscal Year 2021: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000); Fiscal Year 2020: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
• Keywords: 心不全 / 診療の質 / 標準治療 / レジストリ / Patient Experience / 標準診療

Outline of Research at the Start

心不全診療において、患者視点での標準診療の遵守状況の客観的評価方法（Patient Experience）を開発する。さらに、作成した指標を申請者らが運営する心不全多施設レジストリ内で使用して評価し、その結果を現場医師へフィードバックする。最終的に、現場医師の自発的な行動変容を促し、標準診療の遵守率向上に繋げることを目的とする。

Outline of Final Research Achievements

The underutilization of conventional guideline-directed medical therapy (GDMT; angiotensin-converting enzyme inhibitor, beta-blocker and mineral corticosteroid receptor antagonist) was observed among heart failure (HF) patients among our multicenter registry of HF patients (~30%) [Shoji et al. IJC 2022]. To improve optimization of GDMT in wide array of real-world HF patients, appropriateness use criteria (AUC) for HF patients has been installed via support by the Ministry of Health, Labor and Welfare in Japan [Shoji et al. ESC heart failure 2021]. This AUC provide a practical guide for physicians regarding situations commonly encountered in daily practice (e.g., advanced age or chronic kidney disease). Further efforts to optimize GDMT is required to improve outcomes of HF patients.

Academic Significance and Societal Importance of the Research Achievements

心不全は標準薬物治療を導入することが予後改善やQOL向上のために重要であるにも関わらず、その遵守率が低いことが大きな社会問題になっている。我々の研究でも、心不全標準治療薬（conventional GDMT: RAS阻害薬、β遮断薬、MRA）3剤が30％程度にしか導入されていないことが明らかになっている。この状況を打破するためのシステム構築（データでのフィードバック、適切性基準の開発、患者視点からのフィードバック）は急務であり、本研究でその大枠を構築することができた。本手法は他医療分野でも応用可能であり、他分野でも診療の質向上の方策として期待される。

Research Products

• [Journal Article] Regional variations in the process of care for patients undergoing percutaneous coronary intervention in Japan. (2022)
  • Author(s): Shoji S, Yamaji K, Sandhu AT, Ikemura N, Shiraishi Y, Inohara T, Heidenreich PA, Amano T, Ikari Y, Kohsaka S.
  • Journal Title: Lancet Reg Heal - West Pacific Volume: 22 Pages: 100425-100425
  • DOI: 10.1016/j.lanwpc.2022.100425
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Conventional medical therapy in heart failure patients eligible for the PARADIGM-HF, DAPA-HF, and SHIFT trials (2022)
  • Author(s): Satoshi Shoji, Shun Kohsaka, Yasuyuki Shiraishi, Takashi Kohno, Mitsuaki Sawano, Nobuhiro Ikemura, Nozomi Niimi, Yuji Nagatomo, Toshikazu D Tanaka, Makoto Takei, Tomohiko Ono, Munehisa Sakamoto, Shintaro Nakano, Iwao Nakamura, Soushin Inoue, Keiichi Fukuda, Tsutomu Yoshikawa
  • Journal Title: Int J Cardiol Volume: S0167-5273 Pages: 76-83
  • DOI: 10.1016/j.ijcard.2022.04.020
  • Peer Reviewed / Open Access
• [Journal Article] Assessment of coding-based frailty algorithms for long-term outcome prediction among older people in community settings: a cohort study from the Shizuoka Kokuho Database. (2022)
  • Author(s): Nishimura S, Kumamaru H, Shoji S, Nakatani E, Yamamoto H, Ichihara N, Miyachi Y, Sandhu AT, Heidenreich PA, Yamauchi K, Watanabe M, Miyata H, Kohsaka S.
  • Journal Title: Age Ageing Volume: 51 Pages: 1-9
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Impact of Left Ventricular Chamber Size on Outcome in Heart Failure with Preserved Ejection Fraction. (2022)
  • Author(s): Ogawa S, Nagatomo Y, Takei M, Saji M, Goda A, Kohno T, Nakano S, Nishihata Y, Ikegami Y, Shoji S, Shiraishi Y, Kohsaka S, Yoshikawa T.
  • Journal Title: Int Heart J. Volume: 63 Pages: 62-72
  • NAID: 130008145736
  • Peer Reviewed
• [Journal Article] Electrocardiographic Left Atrial Abnormality and B-Type Natriuretic Peptide in a General Japanese Population: NIPPON DATA2010 (2021)
  • Author(s): Shoji Satoshi、Kohsaka Shun、Sawano Mitsuaki、Okamura Tomonori、Hirata Aya、Sugiyama Daisuke、Ohkubo Takayoshi、Nakamura Yasuyuki、Watanabe Makoto、Kadota Aya、Ueshima Hirotsugu、Okayama Akira、Miura Katsuyuki、for the NIPPON DATA2010 Research Group
  • Journal Title: Journal of Atherosclerosis and Thrombosis Volume: 28 Issue: 1 Pages: 34-43
  • DOI: 10.5551/jat.54171
  • NAID: 130007965091
  • ISSN: 1340-3478, 1880-3873
  • Year and Date: 2021-01-01
  • Peer Reviewed / Open Access
• [Journal Article] Incidence and long-term outcome of heart transplantation patients who develop postoperative renal failure requiring dialysis. (2021)
  • Author(s): Shoji S, Kuno T, Kohsaka S, Amiya E, Asleh R, Alvarez P, Kampaktsis P, Staffa SJ, Zurakowski D, Doulamis I, Briasoulis A.
  • Journal Title: J Hear Lung Transplant Volume: 41 Issue: 3 Pages: 356-364
  • DOI: 10.1016/j.healun.2021.11.017
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Different impact of beta-blockers on long-term mortality in heart failure patients with and without chronic obstructive pulmonary disease. (2021)
  • Author(s): Higuchi S, Kohno T, Kohsaka S, Shiraishi Y, Takei M, Goda A, Shoji S, Nagatomo Y, Yoshikawa T.
  • Journal Title: J Clin Med. Volume: 10 Pages: 4378-4378
  • Peer Reviewed
• [Journal Article] Phenomapping in patients experiencing worsening renal function during hospitalization for acute heart failure. (2021)
  • Author(s): Yagi R, Takei M, Kohsaka S, Shiraishi Y, Ikemura N, Shoji S, Niimi N, Higuchi S, Goda A, Kohno T, Nagatomo Y, Nishihata Y, Sujino Y, Saji M, Ikegami Y, Nakano S, Takahashi T, Fukuda K, Yoshikawa T.
  • Journal Title: ESC Hear Fail Volume: 13 Pages: 1-12
  • Peer Reviewed / Open Access
• [Journal Article] De-Escalation of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndromes. (2021)
  • Author(s): Shoji S, Kuno T, Fujisaki T, Takagi H, Briasoulis A, Deharo P, Cuisset T, Latib A, Kohsaka S.
  • Journal Title: J Am Coll Cardiol. Volume: 78 Pages: 763-777
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Evidence‐to‐Practice Gap for Preventing Procedure‐Related Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention. (2021)
  • Author(s): Shoji S, Sawano M, Sandhu AT, Heidenreich PA, Shiraishi Y, Noma S, Suzuki M, Numasawa Y, Fukuda K, Kohsaka S.
  • Journal Title: J Am Heart Assoc. Volume: 10
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Revisiting the Role of Guideline-Directed Medical Therapy for Patients with Heart Failure and Severe Functional Mitral Regurgitation (2021)
  • Author(s): Kohsaka Shun、Saji Mike、Shoji Satoshi、Matsuo Keisuke、Nakano Shintaro、Nagatomo Yuji、Kohno Takashi
  • Journal Title: Cardiology Clinics Volume: 39 Issue: 2 Pages: 255-265
  • DOI: 10.1016/j.ccl.2021.01.008
  • Peer Reviewed
• [Journal Article] Appropriateness rating for the application of optimal medical therapy and multidisciplinary care among heart failure patients. (2021)
  • Author(s): Shoji S, Kohsaka S, Shiraishi Y, Oishi S, Kato M, Shiota S, Takada Y, Mizuno A, Yumino D, Yokoyama H, Watanabe N, Isobe M.
  • Journal Title: ESC Hear Fail. Volume: 8 Pages: 300-308
  • Peer Reviewed / Open Access
• [Journal Article] Incidence of adverse cardiovascular events in type2 diabetes mellitus patients after initiation of glucose‐lowering agents: A population‐based community study from the Shizuoka Kokuho database (2021)
  • Author(s): Kohsaka Shun、Kumamaru Hiraku、Nishimura Shiori、Shoji Satoshi、Nakatani Eiji、Ichihara Nao、Yamamoto Hiroyuki、Miyachi Yoshiki、Miyata Hiroaki
  • Journal Title: Journal of Diabetes Investigation Volume: - Issue: 8 Pages: 1452-1461
  • DOI: 10.1111/jdi.13485
  • Peer Reviewed / Open Access
• [Journal Article] Appropriateness rating for the application of optimal medical therapy and multidisciplinary care among heart failure patients (2020)
  • Author(s): Shoji Satoshi、Kohsaka Shun、Shiraishi Yasuyuki、Oishi Shogo、Kato Mahoto、Shiota Shigehito、Takada Yasuko、Mizuno Atsushi、Yumino Dai、Yokoyama Hiroyuki、Watanabe Noboru、Isobe Mitsuaki
  • Journal Title: ESC Heart Failure Volume: 8 Issue: 1 Pages: 300-308
  • DOI: 10.1002/ehf2.13062
  • Peer Reviewed / Open Access
• [Journal Article] Association of Diagnostic Coding‐Based Frailty and Outcomes in Patients With Heart Failure: A Report From the Veterans Affairs Health System (2020)
  • Author(s): Kohsaka Shun、Sandhu Alexander T.、Parizo Justin T.、Shoji Satoshi、Kumamamru Hiraku、Heidenreich Paul A.
  • Journal Title: Journal of the American Heart Association Volume: 9 Issue: 24
  • DOI: 10.1161/jaha.120.016502
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Applicability and Eligibility of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) for Patients who Underwent Revascularization with Percutaneous Coronary Intervention (2020)
  • Author(s): Niimi Nozomi、Sawano Mitsuaki、Ikemura Nobuhiro、Nagai Toshiyuki、Nakano Shintaro、Shoji Satoshi、Shiraishi Yasuyuki、Ueda Ikuko、Numasawa Yohei、Suzuki Masahiro、Noma Shigetaka、Fukuda Keiichi、Kohsaka Shun
  • Journal Title: Journal of Clinical Medicine Volume: 9 Issue: 9 Pages: 2889-2889
  • DOI: 10.3390/jcm9092889
  • Peer Reviewed / Open Access
• [Journal Article] Antithrombotic Strategy for Patients with Acute Coronary Syndrome: A Perspective from East Asia (2020)
  • Author(s): Numasawa Yohei、Sawano Mitsuaki、Fukuoka Ryoma、Ejiri Kentaro、Kuno Toshiki、Shoji Satoshi、Kohsaka Shun
  • Journal Title: Journal of Clinical Medicine Volume: 9 Issue: 6 Pages: 1963-1963
  • DOI: 10.3390/jcm9061963
  • Peer Reviewed / Open Access
• [Journal Article] Hospital meal intake in acute heart failure patients and its association with long-term outcomes (2020)
  • Author(s): Yoshida Taizo、Shoji Satoshi、Shiraishi Yasuyuki、Kawana Masataka、Kohno Takashi、Inoue Kenji、Fukuda Keiichi、Heidenreich Paul A、Kohsaka Shun
  • Journal Title: Open Heart Volume: 7 Issue: 1 Pages: e001248-e001248
  • DOI: 10.1136/openhrt-2020-001248
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Adherence to antihypertensive medication and its predictors among non-elderly adults in Japan (2020)
  • Author(s): Nishimura Shiori、Kumamaru Hiraku、Shoji Satoshi、Sawano Mitsuaki、Kohsaka Shun、Miyata Hiroaki
  • Journal Title: Hypertension Research Volume: 43 Issue: 7 Pages: 705-714
  • DOI: 10.1038/s41440-020-0440-2
  • Peer Reviewed / Open Access
• [Journal Article] Ischemic and Bleeding Events Among Patients With Acute Coronary Syndrome Associated With Low-Dose Prasugrel vs Standard-Dose Clopidogrel Treatment (2020)
  • Author(s): Shoji Satoshi、Sawano Mitsuaki、Sandhu Alexander T.、Heidenreich Paul A.、Shiraishi Yasuyuki、Ikemura Nobuhiro、Ueno Koji、Suzuki Masahiro、Numasawa Yohei、Fukuda Keiichi、Kohsaka Shun
  • Journal Title: JAMA Network Open Volume: 3 Issue: 4 Pages: e202004-e202004
  • DOI: 10.1001/jamanetworkopen.2020.2004
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Presentation] 心不全診療の適切性基準. (2022)
  • Author(s): 庄司聡
  • Organizer: 第86回 日本循環器学会 シンポジウム-22 心不全薬物治療の最前線.
• [Presentation] 国内の PCI に関する Quality Indicatorの Regional Variance について (2022)
  • Author(s): 庄司聡
  • Organizer: 第86回 日本循環器学会 「診療の質の評価企画」報告会
  • Invited
• [Presentation] Under-utilization of conventional guideline-directed medical therapy among patients eligible for the PARADIGM-HF, DAPA-HF and SHIFT trials. (2021)
  • Author(s): Satoshi Shoji
  • Organizer: AHA 2021, Boston (USA)
  • Int'l Joint Research
• [Presentation] De-Escalation of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndromes. (2021)
  • Author(s): Satoshi Shoji
  • Organizer: ESC 2021 (virtual)
  • Int'l Joint Research
• [Book] 心不全×薬×使いわけ (2020)
  • Author(s): 香坂俊 庄司聡
  • Total Pages: 10
  • Publisher: 日本医事新報