S158 Journal of Cardiac Failure Vol. 20 No. 10S October 2014

stress disorder (PTSD), defined as IES-R score of $25, were examined. Results: At0.6, 1.6 and 2.6 years after the Earthquake, mean IES-R score was 9.1 11.5, and 7.5,and the prevalence of PTSD 11.4%, 14.9% and 6.8%, respectively. Subgroup analysisrevealed that patients who still had PTSD at 2.6 years after the Earthquake were char-acterized by more female and more use of sleeping medicines, whereas the diseaseseverity did not differ between patients with and those without PTSD. Conclusions:After the Great East Japan Earthquake, the psychological stress continued to increaseat 0.6 year, but decreased thereafter at 1.6 years in HF patients.

O-077Mismatch of Bilateral Filling Pressures is Effective for Evaluation of RightVentricular DysfunctionDAISUKE NAGATOMO, NORIHIKO KOTOOKA, JUN-ICHI OYAMA, KOUICHINODEThe Department of Cardiology, Saga University

Background: The right ventricular (RV) filling pressure (right atrial pressure (RAP))correlates to the left ventricular filling pressure (pulmonary capillary wedge pressure(PCWP)) under the left-sided heart failure. However in some patients, bilateral fillingpressures do not correlate and this discordance may be the subject of RV function.Method: There were 542 patients who underwent right heart catheterization inSaga University Hospital from January 2009 to July 2013. We investigated 119 pa-tients corresponded to the criteria of post capillary pulmonary hypertension. Patientswere categorized as high matched (RAP O10, PCWP O22 mmHg), high-Rmismatch (RAP O10 but PCWP !22 mmHg) or high-L mismatch (PCWP O22but RAP !10 mmHg). Result: Among 119 patients, 25 (21.0%) were high matched,40 (33.6%) were high-L mismatch, and 15 (12.6%) were high-R mismatch. Althoughclinical parameters were the worst in high matched group, RV stroke work index(RVSWI) was significantly worst in high R mismatch group (p50.44). BNP levelsand prognosis were not different between groups. Conclusion: These data suggestedthat high-R mismatch patients may have RV dysfunction compared with highmatched and high-L mismatch patients. Excessive diuretics for high-R mismatch pa-tients may lead to lower left sided filling pressure too much.

O-078Healthcare Economics of Incentives to Encourage Healthy BehaviorTOMOYUKI TAKURA1, KYOICHI MIZUNO2, YUKO KATO3

1Osaka University Graduate School of Medicine, Osaka, Japan, 2Mitsukoshi Healthand Wealfare Foundation, Cardiovascular Institute Hospital, Tokyo, Japan, 3TheCardiovascular Institute, Tokyo, Japan

Objective: Here, to construct a model using rewards to encourage behavior changeand thereby reduce social security costs, we clarified the socioeconomics of healthactivities. Methods: Subjects were 79 people aged 20 to 82 years attending fitnessclubs. The main endpoint was reduction in medical expenses starting from age 40.Disease areas were cardiovascular disease, renal failure disease, diabetes, and“others”, and prevention of related events was set as the secondary endpoint. Systolicblood pressure, body mass index (BMI), prevalence of diabetes (7.4%), rate ofobesity (14.2%), and other parameters were measured, and results were comparedwith national averages. Risks of target events were then quoted from previous studies,and the disease state transition (Markov model) was prepared. Social economy wascalculated by integrating the unit prices of healthcare costs by age group into themodel (Monte Carlo method). Results: BMI (22.15 6 3.19), body fat mass and fatpercentage, and systolic blood pressure (128.77 6 17.77 mmHg) all had statisticallysignificant (p !0.05) negative correlations with utilization frequency (3.7 6 1.4times/week), which increased significantly over the 36-month join duration (p50.007). Expected savings of public health care costs were estimated at 1.532million yen/person. Conclusion: Socioeconomics for participation in health activitieswas promising, and incentives appeared to strongly promote behavior change from ahealthcare economics point of view.

O-079Multicenter Survey on Health-care Costs for Hospitalization of ProvisionalHeart failure Patients Based on Elevated BNP Levels in Hiroshima PrefectureTOSHIRO KITAGAWA1, HIROKI KINOSHITA1, YOSHIHARU SADA1, MARIKOMIZUKAWA2, MAKIKO NAKA2, YASUKI KIHARA1,2

1Department of Cardiovascular Medicine, Hiroshima University Graduate School ofBiomedical & Health Sciences, Hiroshima, Japan, 2Heart Failure Center, HiroshimaUniversity Hospital, Hiroshima, Japan

Background: Long-lasting medical care and substantial costs are emerging problemsfor the management of heart failure patients, but are not understood in Japan.Methods: Adult patients with BNP5100 pg/ml or more/NT-proBNP5400 pg/mlor more measured between January and March 2012 in one of the 11 regional corehospitals in Hiroshima Prefecture were all extracted as the provisional heart failure(p-HF) patients, and studied with their all hospitalization records during the past 3

years. Control patients with BNP!100 pg/ml or NT-proBNP!400 pg/ml werealso all studied as well. Results: A total of 1811 p-HF (1058 male, 76611 yearsold) and 1989 control (1296 male, 70612 years old) patients with at least one hos-pitalization history were enrolled. Total number of hospitalization records were 8087,including 4023 (49.8%) out of cardiovascular departments. In the p-HF patients, thetotal number of hospitalizations was significantly higher (2.261.8 vs. 2.061.7,p50.001), the total hospitalization days (THD) were significantly longer(44.7666.2 vs. 28.7645.5, p!0.0001), and total medical fee for hospitalizations(TMF) was significantly higher (2.7963.03 vs. 2.1062.41 million yen, p!0.0001)than in control patients. TMF showed a positive moderate correlation with THD,both in the p-HF and control patients (r50.6, p!0.0001 for both the groups). Con-clusions: Our survey indicates the real longer-lasting medical care, resulting in high-er costs, for all hospitalizations of p-HF patients in Japan.

O-080Single Code for Chronic Heart Failure in DPC/PDPS is Plausible?YASUHIRO SATOH, TOSHIFUMI NOZATO, YOSHIHIDE TAKAHASHI,RYUICHI KATO, MASAKAZU OHNO, TETUO OUMICardiology Department, NHO Disaster Medical Center

Background: More than 1500 hospitals in Japan use DPC/PDPS by 2014. In thismedical financial system, DPC code is assigned to each disease. Majority of the dis-eases has multiple codes according to the procedure.However, single code is assigned to chronic heart failure (050130xx9900xx). Med-ical cost usually depends on the severity of the disease. We evaluated the plausibilityof DPC/PDPS by reviewing medical records. Method: Medical recordings of DPCcode 050130xx9900xx were extracted from patients who discharged in our centerfrom April 2013 through March 2014. DPC/PDPS and clinical data (NYHA, EF,BNP) were reviewd. Results: 171 patients (mean age 74.9) without additional Kcode were enrolled. NYHA classification is as follows: I, II, III and IV 10,30,64and 67 patients respectively. 53% of patients were HFrEF (EF!45%) and the restwere HFpEF. Mean BNP was 1040 pg/ml. In DPC/PDPS medical payment becomesdecrement according to the duration of hospital stay. 22% of the patients were atstage I, and II 39%, stage III 32%, over stage III 7% respectively. Payment to patientsof HFrEF+NYHA3 is minus (DPC ! conventional payment) at stage II, III and overIII. Also payment to HFrEF+NYHA4 is minus at over stage III. Whereas, payment toHFpEF +NYHA3 and 4 is plus at all stages. Conclusion: DPC/PDPS needs furtherkey elements to coding for heart failure.

O-081Clinical Impact of Cognitive Impairment in Patients with Hospitalized HeartFailureMASAKI ISHIYAMA, TADAFUMI SUGIMOTO, TAKASHI KAMIYAMA,KAZUKI MORI, MASAHIDE HORIGUCHI, TAKESHI TAKAMURA,SHIGETOSHI SAKABE, DAISUKE IZUMI, TETSUYA SEKO, ATSUNOBUKASAIDepartment of Cardiology, Ise Red Cross Hospital, Mie, Japan

Purpose: Hospitalized heart failure (HHF) is a major public health problem insuper-aging society. Although hospitalized elderly patients with cognitiveimpairment (CI) have lower rate of discharge to home compared with thosewithout CI, limited data exist on the impact of CI on the post-discharge siteof care in patients with HHF. Methods: Two hundred eight consecutive HHF pa-tients were enrolled in the study. The primary endpoints were in-hospital death anddischarge to non-home environment. Results: CI was found in 56 patients. In eachof 3 groups categorized by systolic blood pressure on admission (O140 mmHg,100-140 mmHg, and !100 mmHg), the in-hospital death rate were 5%, 10% and23%, respectively. Patients with CI were significantly older and had a significantlylower rate of prescription of angiotensin-converting enzyme inhibitors or angio-tensin receptor blockers (ACEi/ARB) before admission and a significantly higherrate of primary endpoints compared with those without CI (8767 vs. 77613 years,32% vs. 58%, and 61% vs. 17%; P ! .05). There was no significant difference insystolic blood pressure on admission, previous HHF, NYHA class, ejection fraction,in-hospital length of stay, and in-hospital death between the two groups. Conclu-sions: Irrespective of heart failure severity, in-hospital CI is associated withdecreased discharge rate to home and may be resulting from insufficient ACEi/ARB use.

O-082A Case of Takayasu’s Artitis Which Presented as Total Occlusion of RightPulmonary ArteryYURI NARISHIGE, SHIGEFUMI FUKUI, AKIHIRO TSUJI, TAKESHI OGO,NORIFUMI NAKANISHINational Cerebral and Cardiovascular Center

A 59-year-old female with prior history of asthma and ulcerative colitis (UC)visited a clinic with a complaint of shortness of breath. She had treated with