Few recent large-scale studies have evaluated the risks and benefits of continuing oral anticoagulant (OAC) therapy after catheter ablation (CA) for atrial fibrillation (AF). This study evaluated the status of continuation of OAC therapy and the association between continuation of OAC therapy and thromboembolic and bleeding events according to the CHADS₂ score. This retrospective study included data from the Japanese nationwide administrative claims database of patients who underwent CA for AF between April 2014 and March 2021. Patients without AF recurrence assessed by administrative data of the treatment modalities were divided into two groups according to continuation of OAC therapy 6 months after the index CA. The primary outcomes were thromboembolism and major bleeding after a landmark period of 6 months. After inverse probability of treatment weighting analysis, the association between OAC continuation and outcomes was determined according to the CHADS₂ score. Among 231 374 patients included, 69.7%, 21.6%, and 8.7% had CHADS₂ scores of ≤1, 2, and ≥3, respectively. Of these, 71% continued OAC therapy at 6 months. The OAC continuation rate was higher in the high CHADS₂ score group than that in the low CHADS₂ score group. Among all patients, 2451 patients (0.55 per 100 person-years) had thromboembolism and 2367 (0.53 per 100 person-years) had major bleeding. In the CHADS₂ score ≤1 group, the hazard ratio of the continued OAC group was 0.86 [95% confidence interval (CI): 0.74–1.01, P = .06] for thromboembolism and was 1.51 (95% CI: 1.27–1.80, P < .001) for major bleeding. In the CHADS₂ score ≥3 group, the hazard ratio of the continued OAC group was 0.61 (95% CI: 0.46–0.82, P = .001) for thromboembolism and was 1.05 (95% CI: 0.71–1.56, P = 0.81) for major bleeding. This observational study suggests that the benefits and risks of continuing OAC therapy after CA for AF differ based on the patient’s CHADS₂ score. The risk of major bleeding due to OAC continuation seems to outweigh the risk reduction of thromboembolism in patients with lower thromboembolic risk. Status of the continuation of OAC therapy and the association between the continuation of OAC therapy and thromboembolic and bleeding events according to the CHADS₂ score. AF, atrial fibrillation; CA, catheter ablation; HR, hazard ratio; OAC, oral anticoagulant.

Background: Heart failure (HF) is a global burden on healthcare systems, but the literature regarding nationwide trends in the care and outcomes of HF hospitalization in Japan is limited. Therefore, we aimed to investigate the trends in patient characteristics, treatment patterns, and outcomes of patients hospitalized with acute HF.Methods and Results: We used data from the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination database between April 2012 and March 2021 to analyze 840,357 patients aged ≥18 years who were hospitalized with an acute HF diagnosis. Over the study period (2012–2020), the mean (±standard deviation) age increased from 78.9 (±11.9) years to 80.9 (±11.8) years (P for trend <0.001), the proportion of female patients decreased from 48.7% to 47.5% (P for trend=0.02), crude in-hospital mortality rate decreased from 11.5% to 10.9%, and 30-day HF readmissions decreased from 7.4% to 7.0% (both P for trend <0.001). The reduction in outcomes was more apparent in the older age groups. The standardized outcomes demonstrated the same trends as the crude outcomes.Conclusions: Our nationwide hospital admission analysis clarified that patients hospitalized with acute HF were getting older, but mortality and readmission rates also decreased, especially in older patients during the 2010s.

Background: Infective endocarditis (IE) is still a fatal disease, and given its rarity, ongoing updates to patient characteristics and outcomes of IE are essential for providing precision diagnoses and effective treatments. This study sought to examine temporal trends in the clinical characteristics and in‐hospital occurrence of adverse outcomes of IE. Methods and Results: Using the Japan nationwide administrative database, we identified patients with IE in Japan from 2016 to 2021. A total of 17 407 patients with IE (37.8% women; median age, 72 [interquartile range, 59–81] years) were identified. The incidence of IE increased from 2.02 per 100 000 population in 2016 to 2.59 per 100 000 population in 2021. The median age of the patients increased from 70 years in 2016 to 73 years in 2021, and patient backgrounds were becoming more complex. The in‐hospital mortality rate was 14.5%, which significantly increased from 14.1% in 2016 to 15.4% in 2021. Higher age (odds ratio [OR], 1.34 [95% CI, 1.29–1.40]), heart failure (OR, 1.37 [95% CI, 1.18–1.59]), cerebrovascular complications (OR, 1.78 [95% CI, 1.59–1.99]), renal failure (OR, 2.36 [95% CI, 2.06–2.70]), and sepsis (OR, 2.79 [95% CI, 2.48–3.13]), were independently associated with an increased in‐hospital mortality rate. In contrast, cardiac surgery (OR, 0.47 [95% CI, 0.41–0.55]), and a higher number of total cardiac surgeries (OR, 0.77 [95% CI, 0.65–0.92]) independently predicted a lower in‐hospital mortality rate. Conclusions: The characterization and comprehensive analysis of IE in Japan provides valuable insights into the epidemiology, risk factors, and outcomes of IE, which may inform health service planning and treatment strategies.

BACKGROUND: The natural history of myocardial dysfunction in patients with fulminant myocarditis is poorly understood. This study aims to evaluate changes in cardiac function in patients with fulminant myocarditis using a nationwide registry in Japan. METHODS: This retrospective cohort study included patients with biopsy-proven fulminant myocarditis and available for left ventricular ejection fraction (LVEF). We described the LVEF on admission, at discharge, and 1 year after discharge. We divided patients into 2 groups based on LVEF at discharge (reduced ejection fraction of <50% or preserved ejection fraction of ≥50%) and analyzed changes in LVEF and prognosis according to groups. RESULTS: We included 214 patients (the median [first–third quartiles] age of the cohort was 48 [35–62] years, and 63 [38%] were female). Of 153 patients available for LVEF at 1 year, the median (first–third quartiles) LVEF increased from 33% (21–45%) on admission to 59% (49–64%) at discharge and further to 61% (55–66%) at 1 year. Of 153 patients, 45 (29%) and 22 (14%) had LVEF <50% at discharge and at 1 year, respectively. Comparisons between patients with LVEF <50% and those with LVEF ≥50% demonstrated that the former group had a higher adjusted probability of death or heart transplantation (hazard ratio, 8.19 [95% CI, 2.13–31.5]; P =0.002). CONCLUSIONS: Some patients with fulminant myocarditis had left ventricular dysfunction in the chronic phase. Patients with reduced left ventricular function at discharge had a worse prognosis than those with preserved left ventricular function. REGISTRATION: URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045352 ; Unique identifier: UMIN000039763.

The Japanese Catheter Ablation (J‐AB) registry, started in August 2017, is a voluntary, nationwide, multicenter, prospective, observational registry, performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center using a Research Electronic Data Capture system. The purpose of this registry is to collect the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in real‐world settings. During the year 2020, we have collected a total of 84 591 procedures (mean age of 65.8 years and 66.6% male) from 466 participant hospitals. Detailed data were shown in Figures and Tables.

The Japanese Catheter Ablation (J‐AB) registry, started in August 2017, is a voluntary, nationwide, multicenter, prospective, observational registry, performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center using a Research Electronic Data Capture system. The purpose of this registry is to collect the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in the real‐world settings. During the year of 2021, we have collected a total of 89 609 procedures (mean age of 66.1 years and 65.9% male) from 506 participant hospitals. Detailed data are shown in Figures and Tables.