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Associations among cardiovascular and cerebrovascular diseases: Analysis of the nationwide claims-based JROAD-DPC
Michikazu Nakai1, Yoshitaka Iwanaga1, Yoko Sumita1
1National Cerebral and Cardiovascular Center, Suita, Japan.
Insights
Cardiovascular and cerebrovascular diseases significantly impact patient outcomes. Comorbidities or complications increased in-hospital mortality, highlighting the need for integrated prevention and management strategies for these interconnected conditions.
Area of Science:
- Cardiovascular and Cerebrovascular Medicine
- Health Services Research
- Epidemiology
Background:
- Cardiovascular diseases (CVD) and cerebrovascular diseases (CeVD) share common pathologies like atherosclerosis and thromboembolism.
- Understanding the clinical interplay between CVD and CeVD is crucial for improving patient outcomes.
- Existing research may not fully capture the nationwide impact of these interconnected conditions.
Purpose of the Study:
- To investigate the impact of clinical interactions between cardiovascular and cerebrovascular diseases on patient outcomes.
- To analyze the association of comorbidities and complications between CVD and CeVD with in-hospital mortality.
- To evaluate the effect of rehospitalization due to either condition on mortality.
Main Methods:
- Retrospective analysis of a large-scale Japanese nationwide claims-based dataset (2015-2016).
- Inclusion of 2,736,986 inpatient records from 911 hospitals.
- Investigation of comorbidities, complications, rehospitalization, and in-hospital mortality for patients with CVD and CeVD.
Main Results:
- 5.9% of CVD hospitalizations had CeVD comorbidity; 2.1% had CeVD complication, both associated with higher mortality.
- 17.7% of CeVD hospitalizations had CVD comorbidity; 3.3% had CVD complication, with complication linked to higher mortality.
- In-hospital mortality was significantly higher during rehospitalization for the other disease category.
Conclusions:
- Significant associations exist between cardiovascular and cerebrovascular diseases, impacting patient outcomes.
- The presence of cerebrovascular disease as a comorbidity or complication elevates in-hospital mortality in cardiovascular patients.
- Intensified prevention and management strategies for both cardiovascular and cerebrovascular diseases are essential.
Abstract:
Cardiovascular and cerebrovascular diseases are frequently interconnected due to underlying pathology involving atherosclerosis and thromboembolism. The aim of this study was to investigate the impact of clinical interactions among cardiovascular and cerebrovascular diseases on patient outcomes using a large-scale nationwide claims-based dataset. Cardiovascular diseases were defined as myocardial infarction, heart failure, atrial fibrillation, and aortic dissection. Cerebrovascular diseases were defined as cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage. This retrospective study included 2,736,986 inpatient records (1,800,255 patients) at 911 hospitals from 2015 to 2016 from Japanese registry of all cardiac and vascular disease-diagnostic procedure combination dataset. Interactions among comorbidities and complications, rehospitalization, and clinical outcomes including in-hospital mortality were investigated. Among hospitalization records that involved cardiovascular disease, 5.9% (32,686 records) had cerebrovascular disease as a comorbidity and 2.1% (11,362 records) included an incident cerebrovascular complication after hospitalization. Cerebrovascular disease as a comorbidity or complication was associated with higher in-hospital mortality than no cerebrovascular disease (adjusted odds ratio (OR) [95% confidence interval]: 1.10 [1.06-1.14], 2.02 [1.91-2.13], respectively). Among 367,904 hospitalization records that involved cerebrovascular disease, 17.7% (63,647 records) had cardiovascular disease listed as comorbidity and 3.3% (11,834 records) as a complication. Only cardiovascular disease as a complication was associated with higher in-hospital mortality (adjusted OR [95% confidence interval]: 1.29 [1.22-1.37]). In addition, in-hospital mortality during rehospitalization due to the other disease was significantly higher than mortality during the hospitalization due to the first disease. In conclusion, substantial associations were observed between cardiovascular and cerebrovascular disease in a large-scale nationwide claims-based dataset; these associations had a significant impact on clinical outcomes. More intensive prevention and management of cardiovascular and cerebrovascular disease might be crucial.
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