Association of Geographical Distance and Residential Population Density With Clinical Outcomes in Acute Decompensated Heart Failure --Insights From the Kyoto Congestive Heart Failure (KCHF) Registry --

Background: The residential environment may influence access to care and prognosis in patients with heart failure (HF). Evidence on the impact of geographic factors in Japan is limited. We investigated the association of home-to-hospital distance and residential population density with 1-year clinical outcomes in patients hospitalized for acute decompensated HF. Methods and Results: We used the Kyoto Congestive Heart Failure registry to analyze 3,616 patients who were discharged alive after their first hospitalization. Home-to-hospital distance was calculated using road travel distance and dichotomized by the median (8.0 km). Residential density was classified as urban (densely inhabited districts [DID]) or suburban (non-DID). The primary outcome was all-cause death at 1 year, assessed using hospital-stratified Cox proportional hazards models. The median home-to-hospital distance was 8.0 km (interquartile range 4.1-14.5 km); 1,797 (49.7%) patients were in the long-distance group. The long-distance group had a higher risk of all-cause death than the short-distance group (adjusted hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.02, 1.39; P=0.02). As a continuous variable, each doubling of distance was associated with increased all-cause death (HR 1.06; 95% CI 1.02, 1.10). Suburban residence was not significantly associated with the primary outcome compared with urban residence (adjusted HR 1.18; 95% CI 0.99, 1.44; P=0.06). Conclusions: In Japanese patients hospitalized for acute decompensated HF, longer home-to-hospital distance, but not residential population density, was associated with a higher risk of 1-year all-cause death.