Temporal comparison of clinical practice and outcomes in heart failure: the JROADHF and JROADHF-NEXT studies.

Abstract

Advances in therapeutics and interventions have enabled the comprehensive management of patients with heart failure (HF); however, real-world clinical practice remains poorly characterized. This study aimed to evaluate temporal changes in HF management and their impact on patient outcomes. Two large-scale Japanese HF registries were compared: the JROADHF (2013, n = 13 238) and JROADHF-NEXT (2019-21, n = 4016). Propensity score matching (1:1) was performed to compare patient outcomes between cohorts and identify factors associated with outcome improvements. Propensity score matching yielded 2972 patients in each cohort. After matching, guideline-recommended therapy increased for renin-angiotensin system inhibitors (70.9% vs 73.1%), beta-blockers (74.9% vs 80.8%), mineralocorticoid receptor antagonists (54.2% vs 61.1%), cardiac rehabilitation (43.5% vs 88.8%), and nutritional guidance (2.9% vs 56.1%) in the 2013 and 2019-21 cohorts, respectively. The 2019-21 cohort demonstrated 26.7% and 52.1% reductions in 1-year mortality and HF readmission rate (P < .001 for both), respectively, compared with the 2013 cohort. Improved mortality was associated with pharmacotherapy [renin-angiotensin system inhibitors: hazard ratio (HR) .71, 95% confidence interval (CI) .64-.80, P < .001; beta-blockers: HR .85, 95% CI .75-.96, P = .012] and patient education (nutritional guidance: HR .76, 95% CI .64-.89, P = .001). The cohort effect was the strongest predictor of HF readmission (subdistribution HR .49, 95% CI: .43-.57, P < .001). Long-term outcomes of patients with HF improved between 2013 and 2019-21. Guideline-recommended therapy was associated with survival benefit, whereas marked reduction in HF readmission rates coincided with broader changes in post-discharge care and healthcare system.