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The current state of knowledge related to disease management of heart failure (HF) and information coordination practices provided by non-physician healthcare professionals such as nurses and therapists working at home-visit nursing stations in Japan are not well known.A questionnaire survey of healthcare professionals working at home-visit nursing stations was conducted in Kochi Prefecture. Data collected from 151 nurses and therapists were analyzed.Regarding the basic characteristics of the respondents, the majority were in their 30s and 40s, and approximately 75 % were nurses. In terms of HF knowledge, 53.7 % of respondents said that they "knew" about the New York Heart Association classification. A total of 40.0 % of respondents said that they were "aware of the existence of the HF handbook", and only 29.3 % of respondents said that they "knew" the classification of HF stages. When they were asked about their level of satisfaction related to all medical information provided by the hospital and hospital wards, no one was "very satisfied", and the most common response (66.2 %) was "not very satisfied". In the essential medical information that respondents wanted to obtain from hospitals and hospitals wards for managing HF patients at home, "medication at discharge", "current medical history", "fluid intake and restrictions", "symptoms, signs, and response to exacerbation", and "ideal body weight" were the top five contents.In the cross-sectional study targeted healthcare professionals working at home-visit nursing stations in Kochi Prefecture, the current state of knowledge related to HF and information coordination practices among healthcare professionals were not fully satisfactory in HF management. It is necessary to increase educational opportunities regarding HF for them and further promote information sharing.

Background: The full impact of the intake of citrus fruits on the risk of depression in individuals with chronic heart failure (HF) is unknown. Here, we examined the associations between the estimated habitual intakes of citrus fruits and depressive symptoms in patients with chronic HF. Methods: We enrolled 150 stable outpatients with chronic HF who had a history of worsening HF. To assess the patients' daily dietary patterns, we used a brief self-administered diet-history questionnaire to calculate the daily consumption of foods and nutrients. To assess the patients' mental state, we used a nine-item Patient Health Questionnaire (PHQ-9). Results: Twelve patients (8%) were identified as having moderate-to-severe depression (PHQ-9 score > 10). The patients with PHQ-9 > 10 had lower daily intakes of citrus fruits compared to those with no or mild depressive symptoms (PHQ-9 < 10). The daily intakes of various antioxidants, including vitamin C, beta- carotene, and beta-cryptoxanthin, all of which are abundant in citrus fruits, were reduced in the patients with PHQ-9 > 10, accompanied by higher serum levels of 8-isoprostane (an oxidative stress marker). A multivariate logistic regression analysis using forward selection showed that a lowered daily intake of citrus fruits was an independent predictor of the comorbidity of moderate-to-severe depression in patients with chronic HF, after adjustment for age, gender, and the hemoglobin value. Conclusions: A lower daily consumption of citrus fruits was associated with higher prevalence of depression in patients with chronic HF. Our findings support the hypothesis that a daily consumption of citrus fruits has a beneficial effect on the prevention and treatment of depression in chronic HF patients. (C)2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Objective Health literacy (HL) has been recognized as an important concept in patient education and disease management for heart failure (HF). However, previous studies on HL have focused predominantly on the relationships between functional HL (the ability to read and write), comprehensive HL including the ability to access information (communicative HL), and the ability to critically evaluate information (critical HL). Self-care behavior has not been evaluated. This study determined the relationship between functional, communicative, and critical HL and self-care behavior in HF patients. Methods Cross-sectional analysis of the data was completed for HL, HF-related knowledge, and HF-related self-care behaviors. Sociodemographic and clinical characteristics were also assessed. Multivariate linear regression analysis was used to estimate the associations between literacy and self-care behavior. Results 249 patients with HF were assessed (mean age, 67.7 ± 13.9 years). Patients with low HL had poorer knowledge and self-care behavior than those with high HL. Critical HL was an independent determinant of self-care behavior (sβ = −0.154, P = 0.027). Conclusions Critical HL was independently associated with self-care behavior in HF patients. Practice implications Effective intervention should be developed to improve patient skills for critically analyzing information and making decisions.

Background and purpose Hyponatremia is common and is associated with poor in-hospital outcomes in patients hospitalized with heart failure (HF). However, it is unknown whether hyponatremia is associated with long-term adverse outcomes. The purpose of this study was to clarify the characteristics, clinical status on admission, and management during hospitalization according to the serum sodium concentration on admission, and determine whether hyponatremia was associated with in-hospital as well as long-term outcomes in 1677 patients hospitalized with worsening HF on index hospitalization registered in the database of the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Methods and subjects We studied the characteristics and in-hospital treatment in 1659 patients hospitalized with worsening HF by using the JCARE-CARD database. Patients were divided into 2 groups according to serum sodium concentration on admission n = 176; 10.6%) or ≥135 mEq/mL ( n = 1483; 89.4%). Results The mean age was 70.7 years and 59.2% were male. Etiology was ischemic in 33.9% and mean left ventricular ejection fraction was 42.4%. After adjustment for covariates, hyponatremia was independently associated with in-hospital death [adjusted odds ratio (OR) 2.453, 95% confidence interval (CI) 1.265–4.755, p = 0.008]. It was significantly associated also with adverse long-term (mean 2.1 ± 0.8 years) outcomes including all-cause death (OR 1.952, 95% CI 1.433–2.657), cardiac death (OR 2.053, 95% CI 1.413–2.983), and rehospitalization due to worsening HF (OR 1.488, 95% CI 1.134–1.953). Conclusions Hyponatremia was independently associated with not only in-hospital but also long-term adverse outcomes in patients hospitalized with worsening HF.

Summary Background Although many studies have demonstrated the efficacy of disease management programs on mortality, morbidity, quality of life (QOL), and medical cost in patients with heart failure (HF), no study has focused on psychological status as an outcome of disease management. In addition, very little information is available on the effectiveness of disease management programs in other areas than the USA and Europe. Methods The Japanese Heart Failure Outpatients Disease Management and Cardiac Evaluation (J-HOMECARE) is a randomized controlled trial in which 156 patients hospitalized with HF will be randomized into usual care or a home-based disease management arm receiving comprehensive advice and counseling by visiting nurses during the initial 2 months and telephone follow-up for the following 4 months after discharge. This study evaluates depression and anxiety (Hospital Anxiety and Depression Scale), mortality, readmission due to HF, and QOL (Short Form-8). Data are collected during index hospitalization and then 2, 6, and 12 months after discharge. This study started in December 2007, and the final results are expected in 2011. Conclusion The J-HOMECARE will provide important information on the efficacy of disease management for psychological status as well as the effective components of disease management for patients with HF. (ClinicalTrials.gov number, NCT01284400 ).

The RALES trial demonstrated that spironolactone improved the prognosis of patients with heart failure (HF). However, it is unknown whether the discharge use of spironolactone is associated with better long-term outcomes among hospitalized systolic HF patients in routine clinical practice. We examined the effects of spironolactone use at discharge on mortality and rehospitalization by comparing with outcomes in patients who did not receive spironolactone.The JCARE-CARD studied prospectively the characteristics and treatments in a broad sample of patients hospitalized with worsening HF and the outcomes were followed with an average of 2.2 years of follow-up.A total of 946 patients had HF with reduced left ventricular ejection fraction (LVEF) (40%), among whom spironolactone was prescribed at discharge in 435 patients (46%), but not in 511 patients (54%). The mean age was 66.3 years and 72.2% were male. Etiology was ischemic in 39.7% and mean LVEF was 27.1%. After adjustment for covariates, discharge use of spironolactone was associated with a significant reduction in all-cause death (adjusted hazard ratio 0.612, P=.020) and cardiac death (adjusted hazard ratio 0.524, P=.013).Among patients with HF hospitalized for systolic dysfunction, spironolactone use at the time of discharge was associated with long-term survival benefit. These findings provide further support for the idea that spironolactone may be useful in patients hospitalized with HF and reduced LVEF.

SummaryRecent epidemiological studies have demonstrated that nearly half of all patients with heart failure (HF) have preserved left ventricular ejection fraction (HFPEF). Compared to those with reduced EF, patients with HFPEF are older, more likely to be women, less likely to have coronary artery disease, and more likely to have hypertension and atrial fibrillation. Patients with HFPEF receive different pharmacological as well as nonpharmacological treatments from those with reduced EF. Morbidity and mortality in patients with HFPEF are largely similar to those with reduced EF. Although much information has recently been obtained about the clinical characteristics, medications, and outcomes of HFPEF by large-scale clinical and epidemiological studies, effective management strategies need to be established for this type of HF.

INTRODUCTION: As indication for implantable cardioverter defibrillators (ICDs) has expanded, prophylactic implantations have increased. It has been well understood that some ICD recipients have psychological problems. Some of those problems are recognized as maladjustment syndromes. METHODS: We studied 35 ICD recipients regularly followed at outpatient department of Kyushu University Hospital in order to clarify the psychological distress and the quality of their daily lives (QOL). By using questionnaire instruments (SF-8, Beck Depression Inventory, Impact of Event Scale Revised, and State-Trait Anxiety Inventory), we studied their psychological status. RESULTS: Depression, anxiety, and post-stress syndromes existed in 45.5% of the ICD recipients and their QOL was compromised. Female ICD recipients reacted to the stress related to ICD implantation differently from male recipients. Elder ICD recipients had a different way of adjustment from the younger recipients. Various ICD related psychological problems were noted in terms of magnitude and diversity. CONCLUSION: To support ICD recipients both physically and mentally, not only the cardiologists but also specialists from other fields such as psychologists and nurse specialists are needed. Ancillary care must be provided through the support team. Cardiologists who determine whether ICD implantation is required must keep in mind potential psychological sequelae.

Background: Symptomatic patients with severe aortic stenosis (AS) are usually are operative candidates because medical therapy has little to offer. Tolvaptan (TLV) treatment resulted in favorable but modest changes in filling pressures associated with a significant increase inurine output. Therefore,TLVisapotential candidate to improvedecompensated heart failure due to severe AS without hemodynamic instability.Methods: We retrospectively investigated 5 patients over 80 years of age who admitted due to decompensated congestive heart failure with severe AS and treated with tolvaptan from April 2014 to March 2015. Results: Four females and a male were examined. Mean age was 90.666.6 years. Compared to total urine volume of the day before treatment, those of the first day were increased (9286478 vs. 12036517 ml, P50.03). Urine osmolality tended to be increased in the first day of treatment (4086137 vs. 2616155 mOsm, P50.06). NYHA classification was significantly improved 1 week after treatment (3.860.4 vs. 3.060.0, P50.02). BNP levels were decreased 1 week after TLV treatment and at discharge (12646796 vs. 6356470 pg/mL, P50.03, vs. 5386343 pg/mL, P50.03, respectively). Severe adverse events, including death, cardiogenic shock did not occur during TLV treatment. Conclusions: TLV treatment safely improved decompensated heart failure due to AS in old patients. Further prospective studies are warranted to confirm these results.

The effect of sex on the etiology, risk factors, comorbidities, treatment and prognosis in patients with heart failure (HF) encountered in routine clinical practice in Asian populations has not been well described. The objective of the present study was to elucidate sex differences with respect to the clinical characteristics, treatment, and prognosis of HF patients treated in routine clinical practice settings using the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) database, which is a nationwide registry for hospitalized patients with HF in Japan. JCARE-CARD enrolled 2675 patients hospitalized for HF at 164 participating hospitals from January 2005 to June 2006. HF was diagnosed by the simultaneous presence of at least two major criteria or onemajor criterion in conjunctionwith twominor criteria by use of the criteria from the Framingham Heart Study [1]. For each patient, baseline data recorded on the form were: demography; HF causes; comorbidities; complications; clinical status; echocardiographic findings; plasma B-type natriuretic peptide (BNP); and treatments. Longterm follow-up data could be obtained from 2305 patients after hospital discharged. Mean post-discharge follow-up was 2.3±0.7 years.