Quality Indicators in Patient Referral Documents for Heart Failure in Japan

Yoshiharu Kinugasa, Masakazu Saitoh, Toshimi Ikegame, Aoi Ikarashi, Kazushige Kadota, Kentaro Kamiya, Shun Kohsaka, Atsushi Mizuno, Isao Miyajima, Eisaku Nakane, Azusa Nei, Tatsuhiro Shibata, Hiroyuki Yokoyama, Sei Yumikura, Dai Yumino, Noboru Watanabe, Mitsuaki Isobe

Research output: Contribution to journalArticlepeer-review


This study examined quality indicators (QIs) for heart failure (HF) in patients’ referral documents (PRDs). We conducted a nationwide questionnaire survey to identify information that general practitioners (GPs) would like hospital cardiologists (HCs) to include in PRDs and that HCs actually include in PRDs. The percentage of GPs that desired each item included in PRDs was converted into a deviation score, and items with a deviation score of 50 were defined as QIs. We rated the quality of PRDs provided by HCs based on QI assessment. We received 281 responses from HCs and 145 responses from GPs. The following were identified as QIs: 1) HF cause; 2) B-type natriuretic peptide (BNP) or N-terminal pro-BNP concentration; 3) left ventricular ejection fraction or echocardiography; 4) body weight; 5) education of patients and their families on HF; 6) physical function, and 7) functions of daily living. Based on QI assessment, only 21.7% of HCs included all seven items in their PRDs. HCs specializing in HF and institutions with many full-time HCs were independently associated with including the seven items in PRDs. The quality of PRDs for HF varies among physicians and hospitals, and standardization is needed based on QI assessment.

Original languageEnglish
Pages (from-to)278-285
Number of pages8
JournalInternational Heart Journal
Issue number2
Publication statusPublished - 2022 Mar 30


  • Information sharing
  • Regional collaboration

ASJC Scopus subject areas

  • Medicine(all)


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