Despite advances in the treatment of cardiogenic shock (CS), it remains associated with high mortality rates. To improve patient outcomes, management in a dedicated care center has been proposed. However, the definition of a dedicated CS center has not been systematically examined, and no consensus exists across major societies or guidelines. The aim of this scoping review was to identify key elements defining CS centers linked to better patient outcomes and guide future research. This review was conducted in accordance with the PRISMA extension for scoping reviews. The PubMed, Cochrane, and Web of Science electronic databases were systematically searched to identify studies published from inception to July 19, 2023. Twenty observational studies examining hospital characteristics and patient outcomes with CS were included. Higher volumes of CS patients, more board-certified cardiologists, percutaneous coronary intervention (PCI) availability 24/7, and the presence of cardiovascular intensive care units, left ventricular assist device (LVAD) centers, and hub-and-spoke systems were associated with better outcomes. Inconsistent associations were observed for the number of PCIs, extracorporeal membrane oxygenation, and percutaneous microaxial ventricular assist device procedures, and LVAD case volume and the availability of cardiac surgical support were not associated with improved outcomes. This scoping review identified candidate elements of CS centers linked to better outcomes, providing a foundation for developing an optimal CS care system.

Background: Recently, shock teams have been introduced to optimize cardiogenic shock (CS) care; however, their clinical benefits remain unclear. We conducted a systematic review and meta-analysis to assess whether management by a shock team improves outcomes in patients with CS.

Methods and Results: This meta-analysis was conducted according to the PRISMA guidelines. Studies comparing adults with CS managed with or without a shock team were identified from the PubMed, Web of Science, and Cochrane Library databases. The primary outcome was short-term mortality (cardiac intensive care unit, in-hospital, or 30-day mortality); the secondary outcome was bleeding. Of the 7 retrospective cohort studies that met the inclusion criteria, 3 without a critical risk of bias were included in the analysis. Shock team management was significantly associated with lower short-term mortality (odds ratio [OR] 0.52; 95% confidence interval [CI] 0.32–0.85; P=0.010) and bleeding complications (OR 0.62; 95% CI 0.43–0.91; P=0.010). Sensitivity analysis using crude data also supported the mortality benefit (OR 0.68; 95% CI 0.54–0.85; P<0.010). However, no randomized trials were included, and the certainty of evidence was rated very low owing to the risk of bias and inconsistency.

Conclusions: Shock team management may improve short-term outcomes in patients with CS; however, the level of evidence is very low. Further prospective studies are needed to evaluate optimal shock team composition and roles.

Progress in intensive care for cardiovascular disease, including catheter-based therapies and mechanical circulatory support, has improved patient survival. Conversely, the numbers of patients with severe disease and older patients with multimorbidities have increased, resulting in complications during management in the intensive care unit (ICU). In addition to ICU-acquired weakness and delirium, postintensive care syndrome (PICS) has recently been recognized, defined as a prolonged impairment in physical, cognitive, and mental status. Physiotherapy is an important treatment option to prevent and ameliorate PICS. Recently, the goals of early-phase physiotherapy have shifted beyond short-term outcomes, such as reducing the length of ICU and hospital stays and recovery of physical function, to include long-term outcomes, such as return to social activity and reduced rehospitalization. Thus, appropriate physiotherapy management and intervention during the ICU are potentially crucial, because high-quality phase I cardiovascular rehabilitation leads to a seamless approach to the next phase of rehabilitation. This review summarizes current clinical issues, the implementation of assessment and treatment strategies in acute-phase physiotherapy, and future perspectives and challenges in cardiovascular intensive care.

Background: Malnutrition worsens outcomes in heart failure (HF). Although nutritional therapy is important, evidence for enhanced nutritional care (ENC) combined with exercise therapy (ET) is limited.

Methods and Results: This systematic review and meta-analysis evaluated ENC, alone or with ET, in HF. Randomized controlled trials (RCTs) published to March 31, 2023, were identified through comprehensive searches. Meta-analyses used a random-effects model with risk ratios (RRs) or mean differences (MDs) and 95% confidence intervals (CIs). Twenty-five RCTs were included: 20 assessed ENC alone and 5 assessed ENC+ET. ENC alone did not reduce all-cause mortality but was associated with fewer post hoc-defined cardiovascular events (RR 0.64; 95% CI 0.48–0.85), driven largely by 1 study and considered exploratory. ENC+ET improved 6-min walk distance (MD 39.85 m; 95% CI 13.05–66.65) and handgrip strength.

Conclusions: ENC may reduce cardiovascular events and improve physical function in HF, particularly with ET, but evidence is preliminary and large-scale trials are warranted.

Background: This study aimed to evaluate the effects of protein and amino acid supplementation on physical performance in patients with chronic heart failure (CHF).

Methods and Results: Studies from PubMed, the Cochrane Library, CINAHL, Web of Science, and PEDro published up to August 2024 were identified using a comprehensive strategy with no limitations on publication date or language. The primary outcome was physical performance, assessed using the 6-min walk distance (6MWD) test. This study included 15 randomized controlled trials involving a total of 744 patients. Control groups received either a placebo or usual care, including standard heart failure treatment. The meta-analysis demonstrated a significant improvement in 6MWD in the supplementation group compared with controls (mean difference 35.25 m; 95% confidence interval 15.93–54.58; I²=38%). Subgroup analysis showed no significant difference between supplementation alone and supplementation combined with exercise, suggesting independent effects. Patients aged ≥65 years showed similar benefits.

Conclusions: Our meta-analysis indicated that physical performance in patients with CHF was improved by using protein and amino acid supplementation, particularly in older adults or those unable to engage in adequate exercise therapy. However, the overall quality of the evidence was very low.

Background: The clinical implementation of secondary prevention implantable cardioverter-defibrillator (ICD) implantation in hemodialysis (HD) patients in Japan remains poorly characterized. We sought to characterize practice patterns and factors associated with secondary prevention ICD implantation in HD patients surviving cardiac arrest due to ventricular arrhythmias.

Methods and Results: Using the nationwide JROAD-DPC database (2012–2020), we analyzed cardiac arrest survivors with ventricular arrhythmias and no prior ICD. We assessed patient factors associated with ICD implantation and analyzed temporal trends in device selection, institutional and geographical variations in utilization patterns among HD patients. Among 17,653 cardiac arrest survivors, 530 of 1,931 HD patients (27%) received ICDs, significantly lower than 6,870 of 15,722 non-HD patients (44%; P<0.001). Multivariable analysis revealed that HD treatment was an independent negative predictor of ICD implantation (odds ratio 0.42, 95% confidence interval [CI] 0.37-0.47). Subcutaneous-ICD use among HD patients increased significantly from 13% to 32% during 2016–2019 (P<0.001 for trend). Among HD patients, ICD implantation rates were consistent across institutional characteristics and geographical regions.

Conclusions: This nationwide analysis revealed significantly lower secondary prevention ICD use in HD patients compared to non-HD patients, with consistent implementation patterns across Japan’s healthcare system. These findings provide important baseline evidence for developing consensus regarding ICD therapy and underscore the need for future prospective studies to guide optimal ICD selection in this population.

Background: Atrial fibrillation (AF) after bioprosthetic valve (BPV) replacement is common in older patients with multiple comorbidities and is associated with a heightened risk of thromboembolism. Anticoagulation therapy is often indicated, but renal impairment and other comorbidities elevate bleeding risk, making clinical decisions complex. This study compared clinical outcomes between warfarin and direct oral anticoagulants (DOACs) in this high-risk population.

Methods and Results: This subgroup analysis of the BPV-AF Registry included 612 patients treated with oral anticoagulants after BPV replacement, stratified by renal function: normal or mild impairment (creatinine clearance [CCr] ≥50 mL/min), mild-to-moderate impairment (30 mL/min ≤ CCr < 50 mL/min), and moderate-to-severe impairment (15 mL/min ≤ CCr < 30 mL/min). Baseline characteristics and outcomes were analyzed within each stratum. The composite outcome of stroke, systemic embolism, and cardiovascular events was numerically less frequent in the DOAC than warfarin group across all strata, although the differences were not statistically significant. Major bleeding also tended to be lower in the DOAC group.

Conclusions: In this study from a Japanese nationwide registry comparing outcomes of AF patients after BPV replacement with severe renal impairment between those treated with DOACs and those treated with warfarin, comparative conclusions between DOACs and warfarin cannot be drawn because of the small sample size. Nonetheless, both anticoagulants may be acceptable in clinical practice, highlighting the need for individualized decision-making based on patient risk.

Background: Hospitalization-associated disability (HAD) is linked to poor post-discharge outcomes in older individuals with heart failure (HF). We investigated whether HAD could be predicted by physical activity measured using a wearable device.

Methods and Results: We retrospectively analyzed data from 104 older individuals with HF whose physical activity was recorded for 3 consecutive days after initiating cardiac rehabilitation. Physical activity was categorized as sedentary behavior (≤1.5 metabolic equivalents [METs]), light-intensity physical activity (LPA; 1.6–2.9 METs), and moderate-to-vigorous physical activity (≥3.0 METs). HAD was observed in 31 (29.8%) individuals. LPA duration was significantly shorter in the HAD than non-HAD group (mean [±SD] 45.7±24.9 vs. 121.2±67.4 min/day; P<0.0001). In receiver operating characteristic curve analysis, the optimal LPA cut-off was 68 min/day, with 87.1% sensitivity and 80.8% specificity (area under the curve=0.888; P<0.0001).

Conclusions: Physical activity measured using a wearable device may be useful in predicting HAD in older individuals with HF.

Background: Several studies have reported that age influences the severity of hospitalization-associated disability (HAD) after cardiac surgery. However, age-specific differences in the incidence and characteristics of HAD remain unclear. Therefore, this study aimed to clarify the incidence and characteristics of HAD according to age group.

Methods and Results: This prospective, multicenter observational study included 604 patients who underwent elective cardiac surgery at 12 acute-care hospitals. HAD was defined as a decrease of ≥5 points in the Barthel Index score from the preoperative assessment to the discharge assessment. The HAD incidence rate was 6.8% for patients aged 65–74 years, 14.5% for patients aged 75–89 years, and 10.4% overall. The characteristics varied by age group. In the 65–74 age group, the incidence of HAD was influenced by a higher prevalence of comorbidities, level of prehospital nursing care, preoperative left ventricular ejection fraction, intubation time, and physical function. In the 75–89 age group, HAD incidence was associated with Kihon Checklist score, level of nursing care, the use of rehabilitation services, preoperative physical function, and intubation time.

Conclusions: The incidence of HAD in post-cardiac surgery patients was 10.4%, increasing with age. Factors affecting the incidence of HAD differed by age group.

Background: The advent of transcatheter aortic valve implantation (TAVI) has increased the rate of aortic valve treatment in frail older adults. Factors contributing to frailty include sarcopenia (characterized by reduced muscle mass), osteopenia (characterized by decreased bone mineral density), and the newly termed osteosarcopenia, which is characterized by a simultaneous decline in muscle mass and bone mineral density. In this study, we aimed to investigate the impacts of sarcopenia, osteopenia, and osteosarcopenia on the clinical outcomes of TAVI.

Methods and Results: We retrospectively analyzed 490 patients who underwent TAVI for aortic stenosis at Yamaguchi University Hospital between April 2014 and March 2025. Osteopenia, sarcopenia, and osteosarcopenia were diagnosed by preprocedural computed tomography. Patients were classified into normal (N), sarcopenia alone (S), osteopenia alone (O), and osteosarcopenia (OS) groups. Early clinical outcomes and 1-year survival rates exhibited no significant differences among the groups. However, the 5-year survival rates were 94.1%, 77.6%, 60.4%, and 46.5% in the N, S, O, and OS groups, respectively (P<0.05). The Cox proportional hazards model revealed osteosarcopenia as a significant risk factor for late death (hazard ratio, 2.09; P=0.0002).

Conclusions: Preoperative evaluation of muscle mass and bone density aids in stratifying TAVI risk.

Background: Managing heart failure complicated by severe right heart failure with implantable mechanical circulatory support remains a significant challenge. One therapeutic strategy is biventricular assist device (BiVAD) support, typically involving the off-label use of 2 implantable left ventricular assist devices (LVADs). Because the available data of implantable BiVAD support remain limited, we reviewed the data for 6 patients on implantable BiVAD support.

Methods and Results: Between January 2010 and March 2019, 6 patients underwent BiVAD implantation at Osaka University Hospital. Their mean age was 31±11 years, and 2 (33%) were male. The right ventricular assist devices (RVADs) utilized were Jarvik2000 (Jarvik Heart, NY, USA) in 4 patients (67%), and HVAD (HeartWare, Framingham, MA, USA) in 2 patients (33%). The survival rates at 1 and 3 years after BiVAD implantation were 83% and 67%, respectively. Of the 6 patients, 4 underwent heart transplantation at 553, 709, 791, and 1,245 days, respectively, following RVAD implantation; 2 patients died during follow-up at 280 and 511 days, respectively, after RVAD implantation. Stroke occurred in 3 patients. Hemolysis or pump thrombosis occurred in 3 patients. Heart failure occurred in 3 patients. Device-related infection occurred in 1 patient.

Conclusions: Although implantable BiVAD support provided a feasible bridge to transplantation with favorable survival, the high incidence of complications indicates that significant challenges remain in optimizing patient outcomes and emphasizes the necessity for RV-specific device development.

Background: Although pulse rate variability (PRV) is considered a potential surrogate marker for heart rate variability in the assessment of autonomic function, it is not clear whether PRV-derived parameters predict mortality risk in the general population.

Methods and Results: Between 2009 and 2018, a total of 5,943 Japanese individuals, aged 30–79 years, were recruited for a prospective study and followed until the end of 2022. The pulse wave was examined over a 5-min period using a fingertip photoplethysmography sensor to determine the resting heart rate (RHR) and the time and frequency domains of PRV. A Cox proportional hazard model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) of PRV-derived parameters for all-cause mortality using the penalized cubic splines method. During 12.4 years of follow up, 437 deaths were recorded. The HR for mortality, adjusted for sex, age, and community, for the lowest quartiles of the standard deviation of the normal-to-normal intervals (SDNN) increased 1.51 times (95% CI 1.15–1.98) vs. the third quartile. Although mortality risk was attenuated after adjustment for several confounders and RHR, PRV-derived parameters of autonomic function showed significant non-linearity of association with mortality risk in the spline analysis.

Conclusions: Low values of PRV-derived autonomic parameters were associated with an increased risk of all-cause mortality in the general Japanese population.

Background: Although metabolic dysfunction-associated fatty liver disease is typically diagnosed using ultrasonography, the fatty liver index (FLI) offers a simple alternative. Brachial-ankle pulse wave velocity (baPWV) is an established marker of arterial stiffness and a predictor of cardiovascular events. This study investigated the association between FLI and baPWV in a general Japanese population.

Methods and Results: This cross-sectional study included participants aged ≥18 years, excluding those with atrial fibrillation, lower extremity artery disease, severe aortic stenosis, or missing data. The primary outcome was an elevated baPWV (≥1,800 cm/s). Multivariable logistic regression analysis was performed to assess the association between FLI and elevated baPWV, considering FLI both as a categorical variable (low risk: FLI <30; moderate risk: FLI ≥30 and <60; high risk: FLI ≥60) and as a continuous variable (per 10-unit increase). The analysis included 10,122 individuals (mean age 54.3 years; 55% male). In multivariable-adjusted models, the odds of elevated baPWV were significantly higher in the moderate-risk (odds ratio [OR] 1.47; 95% confidence interval [CI] 1.20–1.79) and high-risk (OR 1.78; 95% CI 1.33–2.38) groups, using the low-risk group as the reference category. Each 10-unit increase in FLI was associated with significantly higher odds of the outcome (OR 1.16; 95% CI 1.10–1.22).

Conclusions: FLI showed a significant association with arterial stiffness in the general Japanese population.

Background: Enteral nutrition (EN) is often delayed in critically ill cardiovascular patients due to concerns about bowel ischemia, especially when under vasopressor or mechanical support. We evaluated the impact of a structured EN protocol designed to promote timely and safe nutrition delivery in the Cardiac Care Unit (CCU).

Methods and Results: This single-center retrospective study compared mechanically ventilated CCU patients before (April 2019–March 2020) and after (April 2022–March 2023) protocol implementation. The protocol specified hemodynamic safety thresholds and used a peptide-based formula. Outcomes included EN-related complications, time to EN initiation, and nutritional adequacy within the first week. A total of 116 patients (58 per group) were analyzed. No significant differences were observed in vomiting (P=0.717), diarrhea (P=0.219), or bowel ischemia (P=0.364). The post-protocol group showed a significantly shorter time to EN initiation (median 39.5 vs. 76.0 h; P<0.001). By Day 5, enteral energy adequacy improved (40.8% vs. 12.3%; P<0.001), and protein adequacy increased (62.2% vs. 31.0%; P<0.001). Exploratory analyses showed no significant differences in CCU stay, ventilator-free days, or in-hospital deaths.

Conclusions: The EN protocol enabled earlier initiation and improved EN delivery in high-risk CCU patients without increasing complications, offering a safe and practical approach to narrowing the gap between guidelines and practice.

Background: Studies of off-loading devices for chronic limb-threatening ischemia (CLTI) are scarce. We investigated (1) the effect of the application of early therapy sandals on changes in the Clinical Frailty Scale (CFS) scores of patients with CLTI before and after hospitalization, and (2) adverse events such as wound deterioration and reamputation.

Methods and Results: We retrospectively analyzed the cases of 51 patients (51 limbs) with toe amputation after revascularization and compared 2 groups: patients who did not apply any load during the off-loading duration and focused on resistance training (the ‘usual rehabilitation’ group), and those who used therapeutic sandals and performed walking and aerobic exercises with partial off-loading from an early stage (the ‘orthotic’ rehabilitation group). The before-to-after hospitalization change in the CFS score was 0 (−1, 0) in the usual rehabilitation group, and 0 (0, 1) in the orthotic rehabilitation group (P=0.002), a significant difference. There were no significant between-group differences in wound healing duration (usual rehabilitation group, 48 [19,76.5] days; orthotic rehabilitation group, 41 [27.5,78.8] days) or reamputation rate (usual rehabilitation group, 5 [22%]; orthotic rehabilitation group, 3 [11%]).

Conclusions: The early postoperative use of therapeutic sandals tended to shorten the duration of complete off-loading after toe amputation due to CLTI and to help maintain CFS scores throughout the hospitalization duration. It was also shown to have a minimal impact on treatment delay and reamputation.

Background: B-type natriuretic peptide (BNP) is a key biomarker for heart failure (HF) and widely used for risk stratification. Elevated BNP levels in acute stroke are linked to poor outcomes, but its prognostic value in the post-acute phase remains unclear.

Methods and Results: This retrospective study included 876 patients admitted to a rehabilitation hospital after acute cerebral infarction or hemorrhage between February 2019 and December 2022. Patients were classified into 4 groups based on BNP or N-terminal prohormone of BNP. The primary outcome was all-cause unfavorable events, including in-hospital death or transfer due to worsening condition. The severely elevated BNP group had a significantly higher risk of all-cause unfavorable events (hazard ratio: 2.34; 95% confidence interval: 1.26–4.32) than the normal group. No significant difference was observed in the mildly or moderately elevated BNP groups. BNP showed superior predictive value over HF diagnosis in terms of area under the receiver operating characteristic curve (0.712 vs. 0.691), net reclassification improvement (0.304, P=0.002), and integrated discrimination improvement (0.025, P=0.015). Higher BNP was associated with lower body mass index, reduced estimated glomerular filtration rate, longer time from stroke onset, atrial fibrillation, and cardioembolic stroke.

Conclusions: BNP levels in the post-acute stroke phase were significantly associated with unfavorable outcomes and may serve as a useful prognostic marker.

Background: Frailty is a crucial factor in the prognoses of patients who undergo transcatheter aortic valve implantation (TAVI); however, comprehensive assessments of this parameter are not frequently performed in this regard. This study evaluated the prognostic value of the Kihon Checklist (KCL), which covers physical, cognitive, and social domains, for patients receiving TAVI.

Methods and Results: We retrospectively analyzed data from 986 patients who underwent elective TAVI between May 2017 and September 2022. Frailty was classified according to the KCL as non-frail (for scores of 0–3), pre-frail (4–7), or frail (≥8). The primary outcome measure was all-cause mortality following discharge. Kaplan-Meier, Cox regression, and classification and regression tree (CART) analyses were used. Of the overall patient cohort, 47.4% were classified as frail. Over a mean follow-up period of 968±578 days, 18.1% died. Frailty was significantly associated with higher mortality (adjusted hazard ratio 1.771; 95% confidence interval 1.096–2.862; P<0.02). Impaired socialization and physical function were also found to represent independent predictors of mortality. CART identified socialization as the primary node in the risk stratification.

Conclusions: Preoperative frailty, as defined by the KCL, was found to be independently associated with mortality after TAVI. Social and physical domains were also found to have strong prognostic relevance in this context.

Background: Reliable assessment of pitting edema remains a challenge, especially in remote care, because it is inherently subjective. We developed a video-based deep learning (DL) model to objectively classify the severity of pitting edema.

Methods and Results: A total of 247 videos from 34 consecutive hemodialysis patients were analyzed. A convolutional neural-network (EfficientNetB0) was trained using pre and postpressing pretibial images graded on a 0–4 scale. The model achieved 81.5% accuracy, 81.2% sensitivity, and 81.9% specificity in distinguishing grades 3–4 edema from grades 0–1. For extreme cases (grade 0 vs. 4), accuracy improved to 85.8%.

Conclusions: This pilot study demonstrated feasibility of video-based DL for edema detection. Larger, more diverse datasets and clinical validation are needed for generalization.

Background: Transient high-glucose exposure induces Erk2 phosphorylation and cell proliferation in human coronary artery endothelial cells (HCAEC), but the upstream mechanisms remain unclear.

Methods and Results: HCAEC were exposed to 183 mg/dL L-glucose or D-glucose for 1 h followed by 23 h in a glucose-free medium. Transient high D-glucose decreased miR-138 levels, increased Giα2 protein levels, inactivated Rap1, and activated Ras, leading to Erk2 activation.

Conclusions: Transient high D-glucose exposure activates Erk2 via the miRNA-138/Giα2/Rap1/Ras signaling axis, suggesting a potential therapeutic target for atherosclerosis.

Background: Heart failure (HF) is an increasing public health concern in Japan, largely related to the aging population. This protocol describes the rationale, objectives, and methods of the Hokuriku-plus Heart Failure Registry (HpHFR), designed to establish a comprehensive clinical and digital database to assess novel prognostic indicators in patients with HF.

Methods and Results: HpHFR is a prospective, multicenter observational cohort study that has enrolled patients with acute or chronic HF from 5 Japanese centers. Eligible patients provided informed consent and underwent baseline clinical, laboratory, and biometric assessment, including digital phonocardiography and wearable device data. Follow-up assessment will be conducted at 4, 12, 26, and 52 weeks. Primary outcomes include all-cause death, HF-related hospitalization, and worsening HF. Secondary outcomes are the changes in clinical parameters over time. A digital substudy will investigate continuous biometric monitoring, and a genomic substudy explores the loss of chromosome Y as a prognostic biomarker.

Conclusions: In conclusion, this study protocol summarizes the development of a valuable prospective cohort resource. This registry will provide a unique dataset enabling multifaceted investigations to improve HF prediction and management by systematically integrating comprehensive clinical and laboratory data with biometric indicators derived from digital devices and genomic markers.

Background: Catheter ablation (CA) is a well-established therapy for arrhythmia, but the impact of CA strategies has not been thoroughly investigated. Nagano Prefecture comprises a large geographical area and some hospitals do not have cardiac surgeons, thus limiting the application of CA strategies. The aim of this study was to investigate the detailed strategies for CA in Nagano Prefecture and to clarify their efficacy and safety.

Methods and Results: The Shinshu Catheter Ablation (Shinshu-AB) Registry is a multicenter prospective observational registry. Patients treated with CA for any type of arrhythmia are included. Data on the target arrhythmia(s), CA strategy, outcomes, and complications were collected and analyzed at Shinshu University Hospital. The study was approved by the institutional review boards of all investigational sites and registered in the UMIN Clinical Trials Registry (UMIN-55562). Primary endpoints were the composite incidence of arrhythmia recurrence, procedure-related adverse events, and cardiovascular events. The secondary endpoints were acute success, chronic success for >12 months, and all-cause death.

Conclusions: The Shinshu-AB Registry provides real-world data from the Nagano Prefecture on the outcomes and complications of CA for various types of arrhythmias.

Background: Comprehensive monitoring of cardiovascular disease (CVD) is essential in rapidly aging societies such as Japan. The Japanese Circulation Society (JCS) launched the Japanese Registry Of All cardiac and vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) registry, linking annual JROAD questionnaires with nationwide DPC administrative claims to enable patient-level analyses of hospitalized CVD care. This Protocol Paper presents a comprehensive overview of the registry.

Methods and Results: Using anonymized data (April 2012–March 2023), we described temporal trends in patient demographics, principal CVD diagnoses, major interventions, disease-specific severity, and hospital characteristics. From FY2012–FY2022, participating facilities increased from 610 to 860, with registered patients more than doubling. Median age rose from 73.0 to 75.0 years; patients aged ≥90 years nearly quadrupled. The proportion of angina pectoris admissions declined (26.8% to 11.7%), while absolute numbers remained stable. Atrial fibrillation/flutter admissions rose in both proportion (4.1% to 5.9%) and absolute number. Heart failure admissions increased steadily, with its proportion showing a U-shaped trend. Catheter ablations for atrial fibrillation/flutter increased over fivefold, exceeding 64,000, while percutaneous coronary interventions for acute myocardial infarction surpassed 46,000.

Conclusions: JROAD-DPC now captures over 1.5 million annual CVD hospitalizations, providing a nationwide, large-scale longitudinal view of cardiovascular care in Japan. Its scale and validated coding enable robust analyses of trends and outcomes, supporting national CVD policy evaluation and improvement.