Associations among cardiovascular and cerebrovascular diseases: Analysis of the nationwide claims-based JROAD-DPC dataset

Michikazu Nakai; Yoshitaka Iwanaga; Yoko Sumita; Shinichi Wada; Haruhiko Hiramatsu; Koji Iihara; Takahide Kohro; Issei Komuro; Tomohiro Kuroda; Tetsuya Matoba; Masaharu Nakayama; Kunihiro Nishimura; Teruo Noguchi; Tadamasa Takemura; Teiji Tominaga; Kazunori Toyoda; Kenichi Tsujita; Satoshi Yasuda; Yoshihiro Miyamoto; Hisao Ogawa

doi:10.1371/journal.pone.0264390

Associations among cardiovascular and cerebrovascular diseases: Analysis of the nationwide claims-based JROAD-DPC dataset

PLoS One. 2022 Mar 11;17(3):e0264390. doi: 10.1371/journal.pone.0264390. eCollection 2022.

Authors

Michikazu Nakai¹, Yoshitaka Iwanaga¹, Yoko Sumita¹, Shinichi Wada¹, Haruhiko Hiramatsu¹, Koji Iihara¹, Takahide Kohro², Issei Komuro³, Tomohiro Kuroda⁴, Tetsuya Matoba⁵, Masaharu Nakayama⁶, Kunihiro Nishimura¹, Teruo Noguchi¹, Tadamasa Takemura⁷, Teiji Tominaga⁸, Kazunori Toyoda¹, Kenichi Tsujita⁹, Satoshi Yasuda¹⁰, Yoshihiro Miyamoto¹, Hisao Ogawa¹¹

Affiliations

¹ National Cerebral and Cardiovascular Center, Suita, Japan.
² Department of Medical Informatics, Jichi Medical University Hospital, Shimotsuke, Japan.
³ Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan.
⁵ Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
⁶ Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan.
⁷ Graduate School of Applied Informatics, University of Hyogo, Kobe, Japan.
⁸ Department of Neurosurgery, Tohoku University Hospital, Tohoku University Graduate School of Medicine, Sendai, Japan.
⁹ Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
¹⁰ Department of Cardiovascular Medicine, Tohoku University Hospital, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹¹ President, Kumamoto University, Kumamoto, Japan.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation*
Cardiovascular Diseases* / complications
Cardiovascular Diseases* / epidemiology
Cerebral Hemorrhage / complications
Cerebral Hemorrhage / epidemiology
Hospital Mortality
Hospitalization
Humans
Myocardial Infarction*
Retrospective Studies
Risk Factors

Grants and funding

This research was supported by the Japan Agency for Medical Research and Development (grant number 19ek0210089) and the Ministry of Health, Labour and Welfare’s Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus Program (grant number 21FA1012). The funders played no role in study design, data collection and analysis, decision to publish, and manuscript preparation.