{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T15:51:39Z","timestamp":1783785099965,"version":"3.55.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":803,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Ministry of Health, Labor and Welfare","award":["20AA2005"],"award-info":[{"award-number":["20AA2005"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"Abstract<\/jats:title>\n \n Aims<\/jats:title>\n Heart failure is a significant disease, and its high readmission rate is a big concern. We must identify readmission risk factors and optimize outpatient management to prevent them. This study aims to investigate the readmission risk factors, including outpatient management represented by the number of outpatient visits, and to identify the factors related to frequent outpatient visits.<\/jats:p>\n <\/jats:sec>\n \n Methods and results<\/jats:title>\n We used the diagnosis-procedure-combination database between April 2016 and March 2022. Based on the number of outpatient visits within 60 days after discharge, we categorized patients into &lt;1 visits\/month, (1&lt;, \u22662) visits\/month, and &lt;2 visits\/month and observed the occurrence of 60 days readmission. We performed multiple logistic regression analyses to reveal the readmission risk factors and the association between the number of outpatient visits and readmission. As a subgroup analysis, we conducted the same research in the low- and high-readmission risk groups. We compared medical contents between (1&lt;, \u22662) visits\/month and &lt;2 visits\/month. We analysed 101 239 patients and identified the following factors as a risk of readmission: older age (P &lt; 0.001), female (P = 0.009), longer length-of-hospital-stay (P &lt; 0.001), artificial ventilator (P &lt; 0.001), tolvaptan (P &lt; 0.001), top 50% dosage of loop diuretics (P = 0.036), bottom 50% dosage of class III antiarrhythmic agents (P &lt; 0.001), hypertension (P = 0.005), atrial fibrillation (P &lt; 0.001), dilated cardiomyopathy (P &lt; 0.001), valvular disease (P = 0.021), myocardial infarction (P &lt; 0.001), diabetes (P &lt; 0.001), and renal disease (P &lt; 0.001). We revealed that the risk of readmission increases in &lt;2 visits\/month compared to (1&lt;, \u22662) visits\/month (P &lt; 0.001), whereas the risk of readmission decreases in \u22661 visits\/month compared with (1&lt;, \u22662) visits\/month (P &lt; 0.001). In the subgroup analysis, we found the possibility that some risk factors are specific to the subgroup. We identified that the following factors were related to frequent outpatient visits: older age (P &lt; 0.001), home medical care (P = 0.007), tolvaptan (P &lt; 0.001), top 50% dosage of loop diuretics (P &lt; 0.001), diabetes (P &lt; 0.001), renal disease (P = 0.009), 0\u20132 weeks follow-up (P &lt; 0.001), 2\u20134 weeks follow-up (P &lt; 0.001), cardiac rehabilitation (P &lt; 0.001), and echocardiography (P &lt; 0.001).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study comprehensively identified risk factors for readmission and found outpatient visit is personalized by readmission risk. There is still room to optimize outpatient management. We suggest optimizing outpatient management according to our identified characteristics.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ehf2.14498","type":"journal-article","created":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T01:40:18Z","timestamp":1693618818000},"page":"3299-3310","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Risk Factors of Readmission and the Impact of Outpatient Management in Heart Failure Patients: A National Study in Japan"],"prefix":"10.1093","volume":"10","author":[{"given":"Daisuke","family":"Miyazaki","sequence":"first","affiliation":[{"name":"Department of Health Administration and Policy, Tohoku University Graduate School of Medicine , Sendai ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunio","family":"Tarasawa","sequence":"additional","affiliation":[{"name":"Department of Health Administration and Policy, Tohoku University Graduate School of Medicine , Sendai ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyohide","family":"Fushimi","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Fujimori","sequence":"additional","affiliation":[{"name":"Department of Health Administration and Policy, Tohoku University Graduate School of Medicine , Sendai ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,9,1]]},"reference":[{"key":"2026012113204421300_ehf214498-bib-0001","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1016\/j.jacc.2013.11.053","article-title":"The global health and economic burden of hospitalizations for heart failure: Lessons learned from hospitalized heart failure registries","volume":"63","author":"Ambrosy","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2026012113204421300_ehf214498-bib-0002","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1253\/circj.72.489","article-title":"Impending epidemic: Future projection of heart failure in Japan to the year 2055","volume":"72","author":"Okura","year":"2008","journal-title":"Circ J"},{"key":"2026012113204421300_ehf214498-bib-0003","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1136\/bmj.330.7498.1007","article-title":"Illness trajectories and palliative care","volume":"330","author":"Murray","year":"2005","journal-title":"BMJ"},{"key":"2026012113204421300_ehf214498-bib-0004","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1002\/ehf2.12600","article-title":"Early and long-term outcomes of decompensated heart failure patients in a tertiary-care centre in India","volume":"7","author":"Ganapathi","year":"2020","journal-title":"ESC Heart Fail"},{"key":"2026012113204421300_ehf214498-bib-0005","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1536\/ihj.20-441","article-title":"Serial changes in clinical presentations and outcomes of 5,740 patients requiring repeated hospital admissions (four or more times) due to worsened heart failure","volume":"61","author":"Itoh","year":"2020","journal-title":"Int Heart J"},{"key":"2026012113204421300_ehf214498-bib-0006","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1038\/s41440-020-0505-2","article-title":"Association between the number of hospital admissions and in-hospital outcomes in patients with heart failure","volume":"43","author":"Kaneko","year":"2020","journal-title":"Hypertens Res"},{"key":"2026012113204421300_ehf214498-bib-0007","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.ijcard.2020.12.020","article-title":"Cost of inpatient heart failure care and 30-day readmissions in the United States","volume":"329","author":"Kwok","year":"2021","journal-title":"Int J Cardiol"},{"key":"2026012113204421300_ehf214498-bib-0008","doi-asserted-by":"publisher","first-page":"1915","DOI":"10.1002\/ehf2.13155","article-title":"Resource utilization and costs among patients with heart failure with reduced ejection fraction following a worsening heart failure event","volume":"8","author":"Givertz","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2026012113204421300_ehf214498-bib-0009","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1002\/ehf2.13744","article-title":"Effects of the COVID-19 pandemic on heart failure hospitalizations in Japan: Interrupted time series analysis","volume":"9","author":"Morishita","year":"2022","journal-title":"ESC Heart Fail"},{"key":"2026012113204421300_ehf214498-bib-0010","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1159\/000513213","article-title":"Effects of polymyxin B hemoperfusion on septic shock patients requiring noradrenaline: Analysis of a nationwide administrative database in Japan","volume":"50","author":"Fujimori","year":"2021","journal-title":"Blood Purif"},{"key":"2026012113204421300_ehf214498-bib-0011","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1620\/tjem.252.53","article-title":"Recombinant human soluble thrombomodulin contributes to a reduction in-hospital mortality of acute cholangitis with disseminated intravascular coagulation: A propensity score analyses of a Japanese nationwide database","volume":"252","author":"Tarasawa","year":"2020","journal-title":"Tohoku J Exp Med"},{"key":"2026012113204421300_ehf214498-bib-0012","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s13613-021-00928-z","article-title":"Effectiveness of polymyxin B hemoperfusion for sepsis depends on the baseline SOFA score: A nationwide observational study","volume":"11","author":"Fujimori","year":"2021","journal-title":"Ann Intensive Care"},{"key":"2026012113204421300_ehf214498-bib-0013","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1620\/tjem.2022.J092","article-title":"Effect of postoperative pain management after robot-assisted radical prostatectomy: A study on reducing hospital length of stay and medical costs using Japanese nationwide database","volume":"259","author":"Mizuta","year":"2022","journal-title":"Tohoku J Exp Med"},{"key":"2026012113204421300_ehf214498-bib-0014","volume-title":"(2019) ICD-10 Version","author":"World Health Organization","year":"2019"},{"key":"2026012113204421300_ehf214498-bib-0015","volume-title":"Regional Office for the Western Pacific","author":"World Health Organization","year":"2000"},{"key":"2026012113204421300_ehf214498-bib-0016","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1016\/0895-4356(89)90065-6","article-title":"Improving the sensitivity of the Barthel index for stroke rehabilitation","volume":"42","author":"Shah","year":"1989","journal-title":"J Clin Epidemiol"},{"key":"2026012113204421300_ehf214498-bib-0017","doi-asserted-by":"publisher","first-page":"E586","DOI":"10.1097\/BSD.0000000000000992","article-title":"Comparison of perioperative complications between anterior fusion and posterior fusion for osteoporotic vertebral fractures in elderly patients: Propensity score-matching analysis using nationwide inpatient database","volume":"33","author":"Morishita","year":"2020","journal-title":"Clin Spine Surg"},{"key":"2026012113204421300_ehf214498-bib-0018","doi-asserted-by":"publisher","first-page":"2002","DOI":"10.1002\/hed.26660","article-title":"Identification of risk factors for mortality and delayed oral dietary intake in patients with open drainage due to deep neck infections: Nationwide study using a Japanese inpatient database","volume":"43","author":"Hidaka","year":"2021","journal-title":"Head Neck"},{"key":"2026012113204421300_ehf214498-bib-0019","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1253\/circj.CJ-21-0584","article-title":"Barthel index score predicts mortality in elderly heart failure - a goal of comprehensive cardiac rehabilitation","volume":"86","author":"Katano","year":"2021","journal-title":"Circ J"},{"key":"2026012113204421300_ehf214498-bib-0020","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/s12872-015-0127-9","article-title":"Factors associated with 30-day readmission of patients with heart failure from a Japanese administrative database","volume":"15","author":"Aizawa","year":"2015","journal-title":"BMC Cardiovasc Disord"},{"key":"2026012113204421300_ehf214498-bib-0021","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1136\/emermed-2017-206651","article-title":"Thirty-day hospital readmissions among mechanically ventilated emergency department patients","volume":"35","author":"Page","year":"2018","journal-title":"Emerg Med J"},{"key":"2026012113204421300_ehf214498-bib-0022","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.1253\/circj.CJ-19-0342","article-title":"JCS 2017\/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure - digest version","volume":"2019","author":"Tsutsui","journal-title":"Circ J"},{"key":"2026012113204421300_ehf214498-bib-0023","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1093\/eurheartj\/ehi890","article-title":"Heart failure, chronic diuretic use, and increase in mortality and hospitalization: An observational study using propensity score methods","volume":"27","author":"Ahmed","year":"2006","journal-title":"Eur Heart J"},{"key":"2026012113204421300_ehf214498-bib-0024","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1620\/tjem.2022.J114","article-title":"Risk factors with 30-day readmission and the impact of length of hospital stay on it in patients with heart failure: A retrospective observational study using a Japanese national database","volume":"259","author":"Miyazaki","year":"2023","journal-title":"Tohoku J Exp Med"},{"key":"2026012113204421300_ehf214498-bib-0025","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1253\/circj.69.143","article-title":"Poor prognosis of Japanese patients with chronic heart failure following myocardial infarction-comparison with nonischemic cardiomyopathy","volume":"69","author":"Shiba","year":"2005","journal-title":"Circ J"},{"key":"2026012113204421300_ehf214498-bib-0026","doi-asserted-by":"publisher","DOI":"10.5001\/omj.2020.17","article-title":"Mortality and morbidity in HFrEF, HFmrEF, and HFpEF patients with diabetes in the Middle East","volume":"35","author":"Al-Jarallah","year":"2020","journal-title":"Oman Med J"},{"key":"2026012113204421300_ehf214498-bib-0027","doi-asserted-by":"publisher","first-page":"2563","DOI":"10.1093\/eurheartj\/ehr238","article-title":"Changes in renal function during hospitalization and soon after discharge in patients admitted for worsening heart failure in the placebo group of the EVEREST trial","volume":"32","author":"Blair","year":"2011","journal-title":"Eur Heart J"},{"key":"2026012113204421300_ehf214498-bib-0028","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-044416","article-title":"Impairment in activities of daily living and readmission in older patients with heart failure: A cohort study","volume":"11","author":"Nguyen","year":"2021","journal-title":"BMJ Open"},{"key":"2026012113204421300_ehf214498-bib-0029","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/s12603-018-1111-8","article-title":"Impact of body mass index on activities of daily living in inpatients with acute heart failure","volume":"23","author":"Wakabayashi","year":"2019","journal-title":"J Nutr Health Aging"},{"key":"2026012113204421300_ehf214498-bib-0030","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1016\/j.amjmed.2016.05.008","article-title":"Renin-angiotensin system inhibition and lower 30-day all-cause readmission in Medicare beneficiaries with heart failure","volume":"129","author":"Sanam","year":"2016","journal-title":"Am J Med"},{"key":"2026012113204421300_ehf214498-bib-0031","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.5892","article-title":"Association of Mineralocorticoid Receptor Antagonist Use With All-Cause Mortality and Hospital Readmission in Older Adults With Acute Decompensated Heart Failure","volume":"2","author":"Yaku","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026012113204421300_ehf214498-bib-0032","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1093\/ehjqcco\/qcab086","article-title":"Cardiac rehabilitation for patients with heart failure: Association with readmission and mortality risk","volume":"8","author":"Thygesen","year":"2022","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2026012113204421300_ehf214498-bib-0033","doi-asserted-by":"publisher","first-page":"3002","DOI":"10.1002\/ehf2.13391","article-title":"Early follow-up at outpatient care after discharge improves long-term heart failure readmission rate and prognosis","volume":"8","author":"Matsukawa","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2026012113204421300_ehf214498-bib-0034","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1097\/MLR.0000000000000492","article-title":"Post-discharge follow-up characteristics associated with 30-day readmission after heart failure hospitalization","volume":"54","author":"Lee","year":"2016","journal-title":"Med Care"},{"key":"2026012113204421300_ehf214498-bib-0035","doi-asserted-by":"publisher","first-page":"2894","DOI":"10.1002\/ehf2.12899","article-title":"Trends in cause-specific readmissions in heart failure with preserved vs. reduced and mid-range ejection fraction","volume":"7","author":"Cui","year":"2020","journal-title":"ESC Heart Fail"},{"key":"2026012113204421300_ehf214498-bib-0036","doi-asserted-by":"publisher","first-page":"4271","DOI":"10.1002\/ehf2.14152","article-title":"Prevalence and impact of malnutrition on readmission among hospitalized patients with heart failure in China","volume":"9","author":"Liu","year":"2022","journal-title":"ESC Heart Fail"},{"key":"2026012113204421300_ehf214498-bib-0037","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1002\/ehf2.12486","article-title":"Cardiovascular biomarkers predict post-discharge re-hospitalization risk and mortality among Swedish heart failure patients","volume":"6","author":"Molvin","year":"2019","journal-title":"ESC Heart Fail"},{"key":"2026012113204421300_ehf214498-bib-0038","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1080\/10376178.2017.1290537","article-title":"Strategies to improve self-management in heart failure patients","volume":"53","author":"Toback","year":"2017","journal-title":"Contemp Nurse"},{"key":"2026012113204421300_ehf214498-bib-0039","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1186\/s12913-021-06888-1","article-title":"Examining the association of social risk with heart failure readmission in the Veterans Health Administration","volume":"21","author":"Wray","year":"2021","journal-title":"BMC Health Serv Res"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/10\/6\/3299\/64699207\/eschf_10_6_3299.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/10\/6\/3299\/64699207\/eschf_10_6_3299.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T18:25:02Z","timestamp":1769019902000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/10\/6\/3299\/8284353"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,1]]},"references-count":39,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,9,1]]},"published-print":{"date-parts":[[2023,12,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.14498","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,12]]},"published":{"date-parts":[[2023,9,1]]},"assertion":[{"value":"2023-05-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}