JROADHF-NEXT

Nationwide prospective, multicenter registry of hospitalized HF in Japan🫀 | 4,000+ patients | Biobank | Advancing research & collaborations 🌍

[JROADHF-NEXT @jroadhf_next]

#11. Akama Y, et al. "Implications of Urinary Albumin-to-Creatinine Ratio for Subsequent Kidney Function Decline and Kidney-Related Outcomes in Patients Hospitalized for Worsening Heart Failure: Insights From the JROADHF-NEXT Registry"
J Card Fail. 2026.
https://t.co/X42EaNQ8YT
🫘 JROADHF-NEXT 3107例で退院時UACRを評価し、34%がアルブミン尿（A2/A3）を有していた
📉 UACR高値ほど退院後1年間のeGFR低下が大きく（A1: −2.4 → A2: −4.2 → A3: −5.1 mL/min/1.73 m²）、連続的な関連も認めた
🩺 2年間の腎複合イベントもUACRカテゴリーに伴い段階的に増加（A1: 4.6% → A2: 7.5% → A3: 13.6%）
📊 UACR高値は腎機能とは独立して2年死亡とも関連（A2: HR 1.39、A3: HR 1.55；eGFR追加調整後）
❤️ 心不全退院時のUACRは、死亡リスクだけでなく、その後の腎機能悪化を捉えるcardiorenal risk markerとなる可能性

[JROADHF-NEXT @jroadhf_next]

#11. Akama Y, et al. "Implications of Urinary Albumin-to-Creatinine Ratio for Subsequent Kidney Function Decline and Kidney-Related Outcomes in Patients Hospitalized for Worsening Heart Failure: Insights From the JROADHF-NEXT Registry"
J Card Fail. 2026. Sep 30:S1071-9164(26)00597-X. doi: 10.1016/j.cardfail.2026.09.033.
🫘 Among 3,107 patients from JROADHF-NEXT, 34% had albuminuria (A2/A3) at discharge
📉 Higher UACR was associated with a greater decline in eGFR over 1 year (A1: −2.4 → A2: −4.2 → A3: −5.1 mL/min/1.73 m²), with a graded association across continuous UACR levels
🩺 The 2-year composite kidney-related endpoint increased stepwise across UACR categories (A1: 4.6% → A2: 7.5% → A3: 13.6%)
📊 Higher UACR was also associated with 2-year mortality independent of kidney function (A2: HR 1.39; A3: HR 1.55, additionally adjusted for eGFR)
❤️ UACR measured at HF discharge may serve as an integrated cardiorenal risk marker, providing information on both mortality risk and subsequent kidney deterioration.

[JROADHF-NEXT @jroadhf_next]

#10. Tsuda K, et al. "Association of In-Hospital Mineralocorticoid Receptor Antagonist Initiation With Outcomes According to Guideline-Defined eGFR and Potassium Eligibility in Patients With Heart Failure"
J Cardiol. 2026.
DOI: 10.1016/j.jjcc.2026.09.005
💊 Among 2,792 MRA-naïve patients from JROADHF-NEXT, 48% initiated an MRA during hospitalization
🫘 MRA ineligibility was defined as eGFR ≤30 mL/min/1.73 m² or K ≥5.0 mmol/L, with 27% (n=751) meeting these criteria
📉 In-hospital MRA initiation was associated with a lower 2-year risk of CV death or HF hospitalization (adjusted HR 0.75, 95% CI 0.64–0.88)
🔍 No significant interaction was observed by MRA eligibility (ineligible: HR 0.70; eligible: HR 0.83; P for interaction=0.326), with similarly no interaction across continuous eGFR or potassium levels
❤️ The association was mainly driven by HF hospitalization, highlighting the need for further prospective evaluation of MRA therapy in high-risk patients with impaired kidney function and/or hyperkalemia.

[JROADHF-NEXT @jroadhf_next]

#10. Tsuda K, et al. "Association of In-Hospital Mineralocorticoid Receptor Antagonist Initiation With Outcomes According to Guideline-Defined eGFR and Potassium Eligibility in Patients With Heart Failure"
J Cardiol. 2026.
DOI: 10.1016/j.jjcc.2026.09.005
💊 JROADHF-NEXTから入院時点でMRA未使用の2792例を解析。48%が入院中にMRAを新規開始
🫘 eGFR ≤30 mL/min/1.73 m²またはK ≥5.0 mmol/LをMRA「非適格」と定義し、27%（751例）が該当
📉 入院中のMRA開始は、2年間の心血管死＋心不全再入院の低いリスクと関連（調整HR 0.75, 95% CI 0.64–0.88）
🔍 この関連はMRA適格性による有意なinteractionを認めず（非適格：HR 0.70、適格：HR 0.83、P for interaction=0.326）、eGFR・Kを連続変数としてもinteractionなし
❤️ 関連は主に心不全再入院によるもので、腎機能低下・高Kを有する高リスク患者においてもMRAの意義をさらに検証する必要性を示唆

[JROADHF-NEXT @jroadhf_next]

#9. Inukai K, et al. "Prognostic and Exploratory Neurohormonal Correlates of Hypochloraemia in Heart Failure: A Multicentre Cohort Study"
Heart. 2026.
https://t.co/YpIqYBXMnf
🧂 JROADHF-NEXT 3941例を退院時Cl値で分類し、低Cl血症（≤95 mEq/L）は6.6%
📉 低Cl血症は2年死亡、心血管死、心不全再入院のいずれとも関連し、特に心血管死との強い関連を認めた（調整HR 2.29）
❤️ 一方、非心血管死との関連は調整後には認めず、低Cl血症は主に心血管リスクを反映
🔍 NaとClを同時にモデルに入れてもClは死亡と独立して関連し、Naより高い予後情報を示した
🧪 499例の探索的解析では、urocortin 2（UCN2）高値が低Cl値と弱いながら独立して関連し、Cl調節における神経体液性因子との関連を示唆

[JROADHF-NEXT @jroadhf_next]

#9. Inukai K, et al. "Prognostic and Exploratory Neurohormonal Correlates of Hypochloraemia in Heart Failure: A Multicentre Cohort Study"
Heart. 2026.
https://t.co/YpIqYBXMnf
🧂 Among 3,941 patients from JROADHF-NEXT, 6.6% had hypochloraemia (≤95 mEq/L) at discharge
📉 Hypochloraemia was associated with 2-year mortality, CV death, and HF rehospitalization, with a particularly strong association with CV death (adjusted HR 2.29)
❤️ In contrast, hypochloraemia was not independently associated with non-CV death, suggesting relative specificity for CV risk
🔍 When chloride and sodium were included in the same model, chloride remained independently associated with mortality and provided greater prognostic information than sodium
🧪 In an exploratory analysis of 499 patients, higher circulating urocortin 2 (UCN2) was modestly associated with lower serum chloride, suggesting a potential neurohormonal correlate of chloride dysregulation

[JROADHF-NEXT @jroadhf_next]

#8. Tohyama T, et al. "Temporal Comparison of Clinical Practice and Outcomes in Heart Failure: the JROADHF and JROADHF-NEXT Studies"
Eur Heart J. 2026. (in press)
https://t.co/CiDsevCG6G
🇯🇵 2013年のJROADHFと2019–21年のJROADHF-NEXTを比較し、傾向スコアマッチング後の各2972例を解析
💊 6年間でGDMTに加え、心臓リハビリ（43.5%→88.8%）、栄養指導（2.9%→56.1%）など包括的心不全診療が大きく普及
📉 2019–21年では2013年と比較して、1年死亡率が26.7%、心不全再入院率が52.1%低下
❤️ 死亡率低下はRAS阻害薬、β遮断薬、栄養指導などと関連
🏥 一方、再入院率の大幅な低下は個々の治療よりも「時代（cohort）効果」と強く関連し、退院後ケアや医療システム全体の変化が関与している可能性

[JROADHF-NEXT @jroadhf_next]

#8. Tohyama T, et al. "Temporal Comparison of Clinical Practice and Outcomes in Heart Failure: the JROADHF and JROADHF-NEXT Studies" Eur Heart J. 2026. (in press) https://t.co/CiDsevCG6G
🇯🇵 Compared HF care and outcomes between JROADHF (2013) and JROADHF-NEXT (2019–21), with 2,972 propensity score-matched patients in each cohort
💊 Over 6 years, implementation of GDMT and comprehensive HF care markedly increased, including cardiac rehabilitation (43.5%→88.8%) and nutritional guidance (2.9%→56.1%)
📉 Compared with 2013, the 2019–21 cohort showed 26.7% lower 1-year mortality and 52.1% lower HF readmission
❤️ Lower mortality was associated with RAS inhibitors, β-blockers, and nutritional guidance
🏥 The marked reduction in HF readmission was more strongly associated with the “cohort effect” than with individual interventions, suggesting a potential role of broader changes in post-discharge care and the healthcare system

[JROADHF-NEXT @jroadhf_next]

#7. Matsukawa R, et al. @R1Matsu "Prognostic Impact of a Simple GDMT Score on Clinical Outcomes and Cardiac Reverse Remodeling in Patients with ADHF: Insights from the JROADHF-Next"
CJC Open. 2026. (in press)
https://t.co/ZtwBSrX7P6
❤️ JROADHF-NEXTからHFrEF/HFmrEFの2313例を解析
💊 退院時Simple GDMT Score（薬剤導入＋用量を反映）が高い患者では、2年間の心血管死・心不全再入院リスクが低い傾向（調整HR 0.70）
🫀 高スコア群では1年後のLVEF、左室容積、LV mass、BNP/NT-proBNPなど心リモデリング指標もより良好に変化
📊 GDMTスコア5点以上でイベントリスク低下との関連が示唆
🔥 退院時のGDMT最適化の程度は、その後の予後や心リバースリモデリングと関連する可能性

[JROADHF-NEXT @jroadhf_next]

#7. Matsukawa R, et al. @R1Matsu "Prognostic Impact of a Simple GDMT Score on Clinical Outcomes and Cardiac Reverse Remodeling in Patients with ADHF: Insights from the JROADHF-Next"
CJC Open. 2026. (in press)
https://t.co/ZtwBSrX7P6
❤️ 2,313 patients with HFrEF/HFmrEF from the JROADHF-Next registry
💊 Patients with a higher discharge Simple GDMT Score showed a lower risk of cardiovascular death or HF rehospitalization over 2 years (adjusted HR 0.70)
🫀 Higher GDMT scores were also associated with greater improvement in LVEF, LV volumes, LV mass, and BNP/NT-proBNP at 1 year
📊 A Simple GDMT Score ≥5 was associated with a lower risk of adverse outcomes
🔥More intensive implementation of GDMT at discharge might be associated with favorable clinical outcomes and cardiac reverse remodeling.

[JROADHF-NEXT @jroadhf_next]

#6. Nakade T, et al. "Frailty and Bleeding Events in Heart Failure: Insights from the JROADHF-NEXT"
CJC Open. 2026. (in press)
https://t.co/UYVElaCuzD
🩸 2,940 patients with HF receiving antiplatelet and/or anticoagulant therapy from JROADHF-NEXT
🦯 Higher Clinical Frailty Scale (CFS) categories were associated with a stepwise increase in 2-year bleeding events (2.8% → 5.7% → 7.1%)
📊 Frailty remained independently associated with bleeding risk after adjustment (CFS 6–9 vs 1–3: HR 1.75)
📈 Bleeding events were associated with a higher subsequent risk of all-cause mortality (HR 2.80)
⚠️ As this is observational data and causality cannot be inferred, but frailty assessment may help identify patients at higher bleeding risk during antithrombotic therapy.

[JROADHF-NEXT @jroadhf_next]

#6. Nakade T, et al. "Frailty and Bleeding Events in Heart Failure: Insights from the JROADHF-NEXT" CJC Open. 2026.
https://t.co/UYVElaCuzD
🩸 JROADHF-NEXTから抗血小板薬または抗凝固薬を内服していた2940例を解析 🦯 フレイル（Clinical Frailty Scale）が高いほど、2年間の出血イベント発生率が段階的に上昇（2.8%→5.7%→7.1%） 📊 調整済みCox解析でもフレイルは出血イベントと独立して関連（CFS 6–9 vs 1–3：HR 1.75） 📈 出血イベント発生後は、その後の死亡リスクが高いことと関連（HR 2.80） ⚠️ 観察研究のため因果関係は示せないが、フレイル評価は抗血栓療法中の出血リスク層別化に有用である可能性

[JROADHF-NEXT @jroadhf_next]

#5. Nagao K, et al. "急性心不全入院患者における多面的患者報告アウトカム（PRO）の予後的意義"
JACC Heart Fail. 2026.
https://t.co/GGPpj2Qcql
🧓 JROADHF-NEXTから退院時に3つのPRO（KCCQ, EQ-5D, PHQ-9）が評価可能であった2,434例を解析
📝 PROは互いに中等度の相関を示す一方、既存リスクスコア（GWTG-HF, MAGGIC）とは弱い相関
📊 いずれのPROも不良なカテゴリーほど死亡リスクが高い傾向
📈 リスクスコアにPROを追加すると再分類能・識別能が改善
⚠️ これらのPROは従来のリスクスコアでは捉えきれない側面を反映し、付加的な予後情報を与える可能性

[JROADHF-NEXT @jroadhf_next]

#4. Okabe T, et al. "Prognostic Value of In-Hospital Nutritional Status Improvement in Heart Failure: Insights From JROADHF-NEXT Registry"
Glob Heart. 2026.
https://t.co/RKOTszDkGQ
🧓 812 patients with moderate–severe malnutrition (CONUT ≥5) from the nationwide JROADHF-NEXT registry
📉 20.7% showed improvement in nutritional status during hospitalization
📊 Patients with CONUT improvement had markedly lower 2-year mortality (11.9% vs 30.1%)
📈 After adjustment, CONUT improvement remained associated with lower mortality (HR 0.36)
🥗 Dynamic changes in nutritional status during HF hospitalization may be associated with prognosis

[JROADHF-NEXT @jroadhf_next]

#4. Okabe T, et al. "Prognostic Value of In-Hospital Nutritional Status Improvement in Heart Failure: Insights From JROADHF-NEXT Registry"
Glob Heart. 2026.
https://t.co/RKOTszDkGQ
🧓 JROADHF-NEXT（87施設・4016例）から、中等度以上の栄養障害（CONUT≥5）の812例を解析
📉 入院中に栄養状態が改善（CONUT<5）した患者は20.7%
📊 栄養改善群では2年死亡率が有意に低い（11.9% vs 30.1%）
📈 調整解析でも栄養改善は死亡リスク低下と関連（HR 0.36）
🥗 心不全入院中の栄養状態の変化が予後改善と関連する可能性

[JROADHF-NEXT @jroadhf_next]

📢 A new paper from @jroadhf_next is now published in J Am Coll Cardiol‼️
#3. Nakade T, et al. "Frailty Scale Captures Multidimensional Vulnerability and Predicts Mortality in Heart Failure"
J Am Coll Cardiol. 2025. (in press)
🔗 https://t.co/2dvfEs8XF2
🧓 4,016 hospitalized HF patients from 87 centers across Japan (JROADHF-NEXT)
📏 The Clinical Frailty Scale (CFS) closely reflected both physical and cognitive function, strongly correlating with SPPB and Mini-Cog
📊 Higher CFS scores were associated with stepwise increases in 2-year mortality (CFS 1–2: 4.6% → CFS 7–9: 49.6%)
📈 Adding CFS to prognostic models significantly improved discrimination (AUC 0.726 → 0.752)
❤️ A simple bedside tool that captures multidimensional frailty and integrates prognosis in heart failure!

[JROADHF-NEXT @jroadhf_next]

📢JACCに @jroadhf_next から最新の論文がpublishedです‼️
#3. Nakade T, et al. "Frailty Scale Captures Multidimensional Vulnerability and Predicts Mortality in Heart Failure"
J Am Coll Cardiol. 2025. (in press)
https://t.co/2dvfEs8pPu
🧓 全国87施設・心不全入院患者4016例を対象（JROADHF-NEXT）
📏 Clinical Frailty Scale (CFS)が身体・認知機能をよく反映し、SPPBやMini-Cogと有意に相関
📊 CFS高値ほど2年死亡率が段階的に上昇（CFS 1-2: 4.6% → CFS 7-9: 49.6%）
📈 予後モデルにCFSを加えると識別能が有意に改善（AUC 0.726→0.752）
❤️ 簡便なbedside指標として、多面的脆弱性と予後を統合的に把握可能！