Background:In Japan, the long-term care insurance (LTCI) system has an important role in helping elderly people, but there have been no clinical studies that have examined the relationship between the LTCI and prognosis for patients with acute heart failure (HF).

Methods and Results:This registry was a prospective multicenter cohort, 1,253 patients were enrolled and 965 patients with acute HF aged ≥65 years were comprised the study group. The composite endpoint included all-cause death and hospitalization for HF after discharge. We divided the patients into 4 groups: (i) patients without LTCI, (ii) patients requiring support level 1 or 2, (iii) patients with care level 1 or 2, and (iv) patients with care levels 3–5. The Kaplan-Meier analysis identified a lower rate of the composite endpoint in group (i) than in the other groups. After adjusting for potentially confounding effects using a Cox proportional regression model, the hazard ratio (HR) of the composite endpoint increased significantly in groups (iii) and (iv) (adjusted HR, 1.62; 95% confidence interval [CI], 1.22–1.98 and adjusted HR, 1.62; 95% CI, 1.23–2.14, respectively) when compared with group (i). However, there was no significant difference between groups (i) and (ii).

Conclusions:The level of LTCI was associated with a higher risk of the composite endpoint after discharge in acute HF patients.

背景：在日本，长期护理保险 (LTCI) 系统在帮助老年人方面发挥着重要作用，但尚无临床研究检验 LTCI 与急性心力衰竭 (HF) 患者预后之间的关系.

方法和结果：该注册是一项前瞻性多中心队列，纳入了 1,253 名患者，965 名年龄≥65 岁的急性 HF 患者被纳入研究组。复合终点包括全因死亡和出院后因心衰住院。我们将患者分为 4 组：(i) 没有 LTCI 的患者，(ii) 需要 1 级或 2 级支持的患者，(iii) 具有 1 级或 2 级护理的患者，以及 (iv) 具有 3-5 级护理的患者。Kaplan-Meier 分析确定了组 (i) 中复合终点的发生率低于其他组。使用 Cox 比例回归模型调整潜在混杂效应后，复合终点的风险比 (HR) 在组 (iii) 和 (iv) 中显着增加（调整后的 HR，1.62；95% 置信区间 [CI]，1.22– 1.98 和调整后的 HR，1.62；95% CI，1.23–2.14，分别）与组（i）相比。然而，组（i）和（ii）之间没有显着差异。

结论： LTCI 水平与急性 HF 患者出院后复合终点的较高风险相关。