1. The CHART-2 Study (The Chronic Heart Failure Analysis and Registry in the Tohoku District 2) Source Shiba N, Nochioka K, Miura M, et al. Trend of westernization of etiology and clinical characteristics of heart failure patients in Japan – first report from the CHART-2 study. Circ J. 2011;75(4):823–833.

2. Background Cardiovascular disorders are leading causes of mortality across the globe. Heart failure is the end stage of cardiovascular disorders and hospitalizations due to onset of acute heart failure is a key indicator of the prognosis of cardiovascular disorders. The CHART-2 study examined the etiological trends in patients with heart failure.

3. Aim The specific aims of the CHART-2 study were to elucidate/characterize: 1. Characteristics of patients with overt HF and the associated prognostic risks 2. Characteristics of patients at risk for HF and the factors associated with CVD progression 3. Factors associated with the development of AHFS 4. Prevalence and prognostic impact of metabolic syndrome (MetS) in patients with overt heart failure 5. The association between MetS and the development of AHFS 6. The prevalence and prognostic impact of malignancy in patients with CVD 7. The prevalence of patients needing home nursing care 8. The characteristics of bedridden patients with CVD

4. Methods

5. Key results The study established a clear trend of increasing prevalence of ischemic heart failure The plasma B-type natriuretic peptide (BNP) concentration was mildly elevated in patients with stage B heart failure and in those with CAD without overt HF. Furthermore, the cardiovascular risk profile were similar between groups The severity of prognostic risks such as reduced EF, elevated BNP, comorbidity of chronic kidney disease (CKD), and low hemoglobin levels exacerbated progressively as HF stage progressed Usage of standard medication was low, especially in the stage B patients (Fig. 1)

7. Conclusion The CHART-2 study demonstrated the trend of westernization of ischemic etiology and clinical characteristics of HF patients in Asian population, indicating the importance of appropriate management and prevention of CAD to prevent acute heart failure syndrome. Steps must be taken to ensure optimal usage of standard medications for prevention acute heart failure syndrome in patients with CAD.