Clinical features of patients with decompensated heart failure after the Great East Japan Earthquake

Background: While previous studies reported that a short-term increase in cardiovascular diseases after a great disaster, the occurrence of Heart Failure (HF) and its clinical features have not been rigorously examined. We reviewed this important issue from our experience of the Great East Japan Earthquake. Methods: We retrospectively examined the impact of the earthquake on the occurrence of decompensated HF using the clinical data of our hospital. The diagnosis of symptomatic HF was defined based on the Framingham criteria by well-trained cardiologists. We investigated patient's backgrounds such as age, gender, vital signs at hospitalization, etiology of HF, co-morbidities, place of residence, worsening factors of HF, medications at hospitalization, laboratory data, and echocardiographic data. The number of patients admitted for treatment of decompensated HF and their clinical features were compared between two periods, March.11-September.10, 2011 (after the earthquake) and the same period in the previous year. Results: The number of admission due to decompensated HF increased by 52.7%, from 55 (2010) to 84 (2011). Comparison of clinical features showed that the patients admitted after the earthquake had 1) older age (70.4 vs. 65.2 years, P=0.031), 2) higher systolic blood pressure (140.3 vs. 128.9 mmHg, P=0.039), 3) episodes of evacuation (13.1 vs. 0%, P=0.005), 4) more occurrences of new onset of symptomatic HF due to valvular heart disease (25.0 vs. 10.9%, P=0.040), 5) interruption of drugs (17.9 vs. 0%, P=0.001), 6) more occurrences of infection (32.1 vs. 14.5%, P=0.019), 7) longer time from symptom onset to hospital presentation (9.3 vs. 4.7 days, P=0.014), 8) higher BNP (800.0 vs. 380.1 pg/ml, P=0.005) and CRP levels (2.84 vs. 1.01 mg/dl, P=0.003), 9) lower estimated GFR (46.2 vs. 54.1 ml/min/1.73 cm2, P=0.048) and albumin levels (3.2 vs. 3.5 g/dl, P=0.021), and 10) larger diameter of the inferior vena cava (19.4 vs. 16.7 mm, P=0.008). Conclusions: These results suggest that the Great East Japan Earthquake increased the incidence of HF associated with high blood pressure, interruption of drugs, inflammation, malnutrition and fluid retension. Taking appropriate management to control blood pressure, nutritional status, and hygiene environment may decrease the occurrence of HF in future disaster