患者視点の客観的評価を活用した心不全診療の質向上のための研究

2021 Fiscal Year Annual Research Report

• Project/Area Number: 20K22883
• 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): 2020-09-11 – 2022-03-31
• Keywords: 心不全 / 診療の質 / レジストリ / Patient Experience

Outline of Annual Research Achievements

本研究の目的は、患者自身に実際の診療内容を問うことで、医師の標準診療の遵守状況を客観的に評価できるPX（Patient Experience）という手法を、標準診療の遵守率が特に低い心不全領域で初めて取り入れ、現場医師のより自発的な行動変容を促す手法を提案することであった。

最終年度である本年度は、心不全の標準診療の遵守状況の検証と、その行動変容につなげるためのシステム構築に尽力した。WET心不全レジストリを使用し、EFが低下した心不全（heart failure with reduced ejection fraction: HFrEF）に対して、心不全標準治療薬（RAS阻害薬、β遮断薬、MRA）が十分導入されていないこと（3剤とも導入されている患者は30％程度）を明らかにした [Shoji et al. IJC 2022]。また、実際の心不全の日常臨床では、高齢者や腎機能障害患者等、エビデンスが乏しく至適薬物療法の投与に迷う場面に現実として多く遭遇する。これまでの診療ガイドラインではこうした診療に推奨度を設定する事が困難であったため、現場医師のより実践的な判断を後押しするために、心不全のAUC（適切性基準）を開発した [Shoji et al. ESC heart failure 2021]。さらに、患者側からの診療の質評価のアンケート紙票開発を行い、こちらを我々が運営する心不全レジストリ（WET-HFレジストリ）のプラットフォーム上に追加するためのEDCシステム構築を現在行っている。

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
  • 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: (22)00500-9
  • DOI: 10.1016/j.ijcard.2022.04.020.
  • Peer Reviewed
• [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
  • 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 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
  • 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 Pages: e020047
  • 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 S, Saji M, Shoji S, Matsuo K, Nakano S, Nagatomo Y, Kohno T.
  • Journal Title: Cardiol Clin Volume: 39 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] 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