Award Information

Abe Fellowship 2016
Institutional Affiliation (at time of award):
Visiting Scientist, Global Health and Population, Harvard University
Enforcing the Health System for the Pandemic of Heart Failure in East Asia – A Comparison between Korea and Japan

Although 26 million patients suffer from heart failure (HF)1 worldwide, the prognosis of HF remains poor: half of the patients die within five years after initial diagnosis2. Furthermore, rehospitalization for HF is also very common. Recent research indicate that two out of five HF patients experience more than four times higher rate of hospitalization between their initial diagnosis until their death3. Most of these research are from North America and Europe, however from recent reports from Japan, Korea, and Taiwan, it is shown that there is substantial burden of HF in Asia as well. For instance, there are one million individuals with HF in Japan4 and estimated 0.3 million new cases every year5. Between 2002 to 2013, the prevalence of HF has doubled in South Korea6. However, no studies to date have focused their assessment on East-Asia regarding the quality and care process in comparison with other countries. Preliminarily, I performed the comparison of the registry data from Organisation for Economic Co-operation and Development (OECD) countries: Singapore, and Taiwan. Interestingly, I noticed a large difference in one-year mortality rates between the registries from Korea (21.9%) and Japan (7%, a registry from metropolitan Tokyo). This immense gap should be explored from the health system point of view because the number of individuals with HF will only rise as population ages2, 7, 8. Although Korea and Japan share similar characteristics such as universal health care and ethnically homogeneous aging population, questions need to be raised after observing the gap in one-year mortality after HF admission at the best tertiary hospitals in Korea and Japan. Is it because the risk factors of HF are more prevalent in Korea? Does the problem lay in the process of hospital care? Is it due to patient behavior after discharge? Hospital mortality in Korea and Japan are both beyond average and have no significant difference (Figure 1). In the process of hospital care, although the difference in the prescription rate of beta blockers are noted (Table 1), the gap in the process of care might have a little impact on the long-term outcome as seen in the previous research9 from high-income countries. Recently, new paradigm10 of HF has proposed that comorbidities such as obesity or chronic lung disease will cause a systemic proinflammatory state. Then the proinflammatory state induces the change of myocardial structure and function alterations, which eventually result in HF. Hence, my hypothesis is that the gap in one-year mortality is caused by the difference of patient's comorbidities, such as chronic lung disease. I will obtain the individual data of the registry and then perform the multivariable logistic regression with long-term mortality as a dependent variable and important clinical variables as independent variables. The important clinical variables are country of residence, age, sex, body mass index, current smoker, systolic blood pressure, diabetes, the status of HF at admission, echocardiographic parameters, chronic comorbidities, and prescription of important medications at discharge. We also chose variables based on the externally validated prediction model for HF11. The burden of HF on health system will rapidly increase due to an aging population in Japan, yet, the awareness of the disease is still low among the public, politicians, and some healthcare professionals. Many cases are preventable, and early detection of the symptom can improve the quality of life among HF patients. My study aims to pinpoint what needs to be changed in the health system before HF may turn into a pandemic in East-Asia.