Patient Experienceを活用した虚血性心疾患診療適正化への取り組み

• Project/Area Number: 21K16095
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 53020:Cardiology-related
• Research Institution: Keio University
• Principal Investigator: 庄司 聡 慶應義塾大学, 医学部(信濃町), 共同研究員 (00875411)
• Project Period (FY): 2021-04-01 – 2024-03-31
• Project Status: Granted (Fiscal Year 2022)
• Budget Amount: ¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000); Fiscal Year 2023: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000); Fiscal Year 2022: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000); Fiscal Year 2021: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
• Keywords: 虚血性心疾患 / レジストリ / Patient Experience / 標準治療 / 心不全

Outline of Research at the Start

循環器診療において、適切なエビデンスに基づいた標準診療を遵守することは患者の予後向上のために重要であるが、現実的には標準診療の遵守状況は必ずしも高くなく、医師や施設間でばらつきがあることが知られている。本研究では、医療の中心である患者の立場からも、標準診療の理解およびその遵守に関する問題意識を共有できるような新たなツールを開発し、現場医師のより自発的な行動変容を促すことを目的とする。

Outline of Annual Research Achievements

本研究では、虚血性心疾患において標準診療の遵守状況を評価すること、および、発展的な手法として、患者視点での客観的評価方法 [Patient Experience (PX)] を活用し、現場医師の行動変容を促し、標準診療の遵守率向上に繋げることを目的としている。

2年目である本年度は、虚血性心疾患における標準診療遵守を目的としたリスクスコアの開発を行った。国内最大規模の虚血性心疾患のレジストリ（J-PCI）とレセプトデータ（DPC）の突合を実施し、汎用性の高いリスクモデルの開発に成功した [Shoji et al. IJC 2023]。さらに、同データベースを用いて、標準的アプローチである橈骨動脈穿刺が、コストの面からも大腿動脈穿刺よりもコスト削減に繋がることを明らかにした [Shoji et al. Lancet regional health 2022]。こういった大規模データベースの活用は、参加している現場医師の数も多く、より自分事として捉えやすく、ひいては、現場医師の行動変容につながり、標準診療のさらなる遵守率向上につながるものである。

Current Status of Research Progress

2: Research has progressed on the whole more than it was originally planned.

Reason

循環器急性期疾患に対する標準診療の遵守状況を把握し、その解決策を提示することを目的とした研究は順調に進んでいる。

Strategy for Future Research Activity

最終年度には、患者視点からの標準診療遵守のための手法の開発と臨床現場へのフィードバックを行う予定である。現在、開発に向けた文献レビューと質問票の作成を専属の臨床研究コーディネーターとともに行っている。

Research Products

• [Journal Article] Cardiovascular vs. Non-Cardiovascular deaths after Heart Failure Hospitalization in Young, Older, and Very Old Patients. (2023)
  • Author(s): Nakamaru R, Shiraishi Y, Sandhu AT, Heidenreich PA, Shoji S, Kohno T, Takei M, Nagatomo Y, Nakano S, Kohsaka S, Yoshikawa T
  • Journal Title: ESC Heart Fail. Volume: 10 Issue: 1 Pages: 673-684
  • DOI: 10.1002/ehf2.14245
  • Peer Reviewed / Open Access
• [Journal Article] Risk prediction models in patients undergoing percutaneous coronary intervention: A collaborative analysis from a Japanese administrative dataset and nationwide academic procedure registry (2023)
  • Author(s): Shoji Satoshi、Kohsaka Shun、Kumamaru Hiraku、Nishimura Shiori、Ishii Hideki、Amano Tetsuya、Fushimi Kiyohide、Miyata Hiroaki、Ikari Yuji
  • Journal Title: International Journal of Cardiology Volume: 370 Pages: 90-97
  • DOI: 10.1016/j.ijcard.2022.10.144
• [Journal Article] Contrast volume and in-hospital outcomes of dialysis patients undergoing percutaneous coronary intervention (2022)
  • Author(s): Kuno Toshiki、Numasawa Yohei、Shoji Satoshi、Ueda Ikuko、Suzuki Masahiro、Noma Shigetaka、Fukuda Keiichi、Kohsaka Shun
  • Journal Title: Scientific Reports Volume: 12 Issue: 1
  • DOI: 10.1038/s41598-022-21815-y
• [Journal Article] Cost reduction associated with transradial access in percutaneous coronary intervention: A report from a Japanese nationwide registry (2022)
  • Author(s): Shoji Satoshi、Kohsaka Shun、Kumamaru Hiraku、Yamaji Kyohei、Nishimura Shiori、Ishii Hideki、Amano Tetsuya、Fushimi Kiyohide、Miyata Hiroaki、Ikari Yuji
  • Journal Title: The Lancet Regional Health - Western Pacific Volume: 28 Pages: 100555-100555
  • DOI: 10.1016/j.lanwpc.2022.100555
• [Journal Article] Comparison of Unguided De-Escalation Versus Guided Selection of Dual Antiplatelet Therapy After Acute Coronary Syndrome: A Systematic Review and Network Meta-Analysis (2022)
  • Author(s): Kuno Toshiki、Fujisaki Tomohiro、Shoji Satoshi、Sahashi Yuki、Tsugawa Yusuke、Iwagami Masao、Takagi Hisato、Briasoulis Alexandros、Deharo Pierre、Cuisset Thomas、Latib Azeem、Kohsaka Shun、Bhatt Deepak L.
  • Journal Title: Circulation: Cardiovascular Interventions Volume: 15 Issue: 8
  • DOI: 10.1161/circinterventions.122.011990
• [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] 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] 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] 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: 1-10
  • 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: 15 Issue: 15
  • DOI: 10.1161/jaha.120.020047
  • 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
• [Presentation] シンポジウム4 「より良いACS診療体制の構築」 (2023)
  • Author(s): 庄司聡
  • Organizer: 第87回日本循環器学会学術集会
• [Presentation] YIA Clinical Research Session. Genetic Backgrounds Associated with Stent Thrombosis: A Pilot Study from a Percutaneous Coronary Intervention Registry. (2023)
  • Author(s): 庄司聡
  • Organizer: 第87回日本循環器学会学術集会
• [Presentation] シンポジウム8.「心不全に合併した冠動脈疾患～その閉塞, 拡げますか？～」 (2022)
  • Author(s): 庄司聡
  • Organizer: 第30回日本心血管インターベンション治療学会学術集会 (CVIT)
• [Presentation] シンポジウム28「ACSの抗血小板療法におけるDe-escalation戦略の可能性」 (2022)
  • Author(s): 庄司聡
  • Organizer: 第70回日本心臓病学会学術集会
• [Presentation] 「心不全 X HFpEF」 (2022)
  • Author(s): 庄司聡
  • Organizer: 第26回日本心不全学会学術集会
• [Presentation] Institutional Variation of Transcatheter Edge to Edge Repair for Mitral Regurgitation and Long-Term Outcome: A Report from National Readmission Database. (2022)
  • Author(s): Shoji S, Kuno T, Malik A. et al.
  • Organizer: AHA Congress 2022
• [Presentation] Clinical and genetic factors associated with early and late/very late stent thrombosis: a genome-wide association study within multicenter percutaneous coronary intervention registry in Japan. (2022)
  • Author(s): Shoji S, Sawano M, Kohsaka S. et al.
  • Organizer: ESC Congress 2022
• [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): Shoji S, Kohsaka S, Shiraishi Y. et al.
  • 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): Shoji S, Kuno T, Kohsaka S.
  • Organizer: ESC 2021 (virtual)
  • Int'l Joint Research