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Comparison of the Incidence of Acute Decompensated Heart Failure Before and After the Major Tsunami in Northeast Japan

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On March 11, 2011, a huge tsunami attacked the northeastern coast of Japan after a magnitude 9 earthquake. No reports have investigated the impact of tsunamis on the incidence of cardiovascular disease, especially heart failure (HF). We investigated the number and clinical characteristics of hospitalized patients with acute decompensated HF (ADHF) in the east coast of Iwate hit by the tsunami (tsunami area) for a 12-week period around the disaster. For comparison with previous years, numbers of ADHF were surveyed in the corresponding area in 2009 and 2010. In addition, to elucidate the impact of the tsunami, a similar study was performed in a remote area where the tsunami had minimal effect (control area). After the disaster, the number of patients with ADHF in the tsunami area was significantly increased compared to the predisaster period (relative risk 1.97, 95% confidence interval 1.50 to 2.59). The peak was found 3 to 4 weeks after the disaster. In contrast, in the control area, no significant change in ADHF events was observed (relative risk 1.29, 95% confidence interval 0.94 to 1.78). There was a significant correlation between changes in the number of ADHF admissions and percent tsunami flood area (r = 0.73, p <0.001) or the number of shelter evacuees (r = 0.83, p <0.001). In conclusion, these findings suggest that large and sudden changes in daily life and the trauma associated with a devastating tsunami have a significant impact on the incidence of ADHF.

Section snippets

Methods

To elucidate the effects of tsunami on health problems, we defined 2 areas (Figure 1): the coastal area in the southern San-riku region damaged by the huge tsunami (tsunami area) and the northern San-riku region and inland of Iwate where minimal tsunami damage occurred (control area). The definition was based on the percent tsunami flood area per built-up area (%TFA) in each coastal municipality.1 This ratio represented the degree and extent of damage caused by the tsunami in the residential

Results

In the tsunami area during the 8 weeks after the disaster, 97 patients with ADHF were admitted. Compared to the number of the previous 2 years (n = 104), the relative risk of ADHF incidence in the tsunami area was 1.97 (95% CI 1.50 to 2.59). In contrast, in the control area, the number of hospitalized ADHF cases for the corresponding periods were 96 (sum of 2009 and 2010) and 61 (2011). There was no significant increase in ADHF numbers in the control area (relative risk 1.29, 95% CI 0.94 to

Discussion

The present hospital-based study has demonstrated that the number of cases of ADHF in the area devastated by the huge tsunami increased significantly for several weeks after the disaster, and this growth was significantly correlated with the degree of tsunami-induced destruction in residential areas or with the number of evacuees. In contrast, the number of hospitalized patients with ADHF did not change significantly in towns with a similar magnitude of earthquake but with no critical tsunami

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This study was supported in part by Grant-in-Aid 23591059 from the Scientific Research Fund of the Ministry of Education, Science and Culture of Japan, Tokyo, Japan; Grant 11100775 from the Japan Science and Technology Agency, Saitama, Japan; and the Takeda Science Foundation, Osaka, Japan.

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