Current Status and Barriers to Heart Failure Care in Japanese Geriatric Health Services Facilities - A Nationwide Cross-Sectional Survey.

Abstract

Background: As Japan faces a heart failure (HF) pandemic, geriatric health service facilities (GHSFs) are vital for transitional HF care from hospital to home. This study investigated HF care practices, challenges, and support needs in Japanese GHSFs.

Methods and results: We conducted a cross-sectional web-based survey of 171 GHSFs. We analyzed current management practices, perceived difficulties, and support needs regarding HF care in GHSFs. Concerns over high medication costs for HF were the primary reason for admission refusal (49.7%). Although daily symptom assessments, including dyspnea and edema were common, weight monitoring was conducted only monthly in 50.3% of facilities. HF care infrastructure was inadequate: 99.4% of GHSFs had no specialized staff (e.g., certified HF educators), only 38.0% had access to expert consultation, and only 56.7% provided HF-specific rehabilitation. Consequently, 44.4% of representatives reported significant perceived difficulty in HF care, primarily in judging consultation timing (75.0%). Facilities reporting low/neutral satisfaction with information desired advance care planning (ACP) and consultation criteria. HF patients had significantly lower home discharge rates than the overall facility residents (median [interquartile range] 20.0% [4.1-34.6%] vs. 34.0% [19.0-49.0%]; P<0.01).

Conclusions: Concerns over financial barriers, along with structural and communication barriers in GHSFs, drive admission refusals and complicate HF management, potentially limiting home discharge. Improving transitional HF care requires addressing these financial concerns, providing standardized staff education and specialized support, and bridging information gaps, specifically regarding ACP and consultation criteria, between hospitals and facilities.