Ueda, Ikuko

写真a

Affiliation

School of Medicine, Department of Internal Medicine (Cardiology) (Shinanomachi)

Position

Project Assistant Professor (Non-tenured)/Project Research Associate (Non-tenured)/Project Instructor (Non-tenured)
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Research Areas 【 Display / hide 】

  • Life Science / Pharmacology

  • Life Science / Clinical pharmacy (drug-induced gastrointestinal bleeding)

  • Life Science / Medical management and medical sociology

  • Informatics / Life, health and medical informatics (Healthcare Digital Transformation)

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Papers 【 Display / hide 】

  • Comparative incidence and risk factors for gastrointestinal bleeding following percutaneous coronary intervention for coronary artery disease: Insights from the Keio Cardiovascular Registry in Japan

    Ueda I., Kohsaka S., Numasawa Y., Takemura R., Hosoe N., Ieda M.

    Thrombosis Research 243 2024.11

    ISSN  00493848

    　View Summary

    Background: In patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), antiplatelet medication usage is crucial for preventing thrombotic events. However, it requires careful monitoring, especially because of the risk of life-threatening bleeding complications. In hemorrhagic complications, assessment of patient background and risk of gastrointestinal bleeding (GIB) remain limited for GIB that develops during long-term observation after hospital discharge. This study aimed to examine the incidence of GIB and patient characteristics in CAD post-PCI. Methods: All CAD patients undergoing PCI for urgent, emergent, or elective indications were enrolled in the Keio Interhospital Cardiovascular Studies (JCD-KiCS)-PCI registry (January 2009 and December 2017) and followed up to 2 years after PCI discharge. From the JCD-KiCS PCI registry, 8864 patients (median [interquartile range [IQR]] age: non-GIB: 69.0 y [16 y], upper GIB (UGI): 72.0 y [15.5 y], lower GIB (LGI): 73.0 y [IQR: 13 y]) were categorized based on the occurrence of hospitalization-requiring GIB. Patient characteristics and detailed information regarding these GIB events, including the location (upper vs lower GI) and bleeding severity, were analyzed. Results: Overall, 36 patients experienced UGI, while 85 patients experienced LGI. The rates of dual antiplatelet therapy (DAPT) and triple therapy were significantly different among the non-GIB (n = 8734), UGI (n = 36) and LGI (n = 85) groups (DAPT [aspirin + P2Y12 (clopidogrel/prasugrel/ticlopidine)]: 64 [76.2 %] in the LGI group vs 24 [68.6 %] in the UGI group vs 7330 [84.6 %] in the non-GIB group; triple therapy [aspirin + P2Y12 (clopidogrel/prasugrel/ticlopidine)] + oral anticoagulant (OAC) (warfarin/direct oral anticoagulant [DOAC]): 17 [20.2 %] in the LGI group vs 8 [22.9 %] in the UGI group vs 836 [9.6 %] in the non-GIB group; p < 0.001). In the LGI and UGI groups, aspirin and warfarin were used in 2 (2.4 %) and 2 (5.7 %) patients, respectively, but not in combination with DOAC. The 2-year post-PCI hospitalization incidence for GIB was 1.4 % (LGI, 1.0 %; UGI, 0.4 %). The most common causes were colonic diverticular hemorrhage (43.5 %) for LGI and duodenal ulcer (21.9 %) for UGI. No significant differences were found in the cumulative 2-year post-PCI risks between the LGI and UGI groups (log-rank p = 0.97). Most GIB events were Bleeding Academic Research Consortium 2-equivalent (hemoglobin decrease <3 g/dL). Notably, the use of OACs at PCI discharge, bleeding complications within 72 h, and preprocedural anemia were significantly correlated with an increased GIB risk. Conclusions: The real-world incidence of LGI is two times higher than that of UGI in CAD patients undergoing PCI, and most events are mild. OAC use at PCI discharge is the strongest potential risk factor for GIB development.

  • Predictors and incidence of health status deterioration in patients with early atrial fibrillation

    Miyama H., Ikemura N., Kimura T., Katsumata Y., Yamashita S., Yamaoka K., Ibe S., Sekine O., Ueda I., Nakamura I., Negishi K., Kohsaka S., Takatsuki S., Ieda M.

    Heart Rhythm 21 ( 9 ) 1469 - 1476 2024.09

    ISSN  15475271

    　View Summary

    Background: Various treatment approaches for atrial fibrillation (AF) have demonstrated improved health status, yet the significance of these therapeutic interventions in individual patients remains unclear. Objective: This study aimed to evaluate health status changes in patients with early AF, focusing on those who experience clinically significant deterioration after treatment initiation. Methods: We analyzed data from a multicenter, prospective registry of newly diagnosed patients with AF. One-year changes in health status across different treatment strategies were assessed by the Atrial Fibrillation Effect on QualiTy-of-life Overall Summary (AFEQT-OS) score. Clinically relevant deterioration and improvement in health status were defined as ≥5-point decrease and increase in AFEQT-OS score, respectively; no change was −5 to 5 points. Results: Overall, 1960 patients with AF were evaluated. Mean AFEQT-OS scores at baseline and 1-year follow-up were 76.7 ± 17.7 and 85.4 ± 14.8, respectively. Although most patients (53.9%) experienced clinically important improvement, a considerable proportion had no change (28.7%) or deterioration (17.4%) in their health status. Proportions of patients with no change or deterioration varied by treatment strategy: 59.9%, 53.9%, and 32.0% in rate control, antiarrhythmic drug, and catheter ablation groups, respectively. The multivariable model identified older age, female sex, heart failure, coronary artery disease, and higher baseline AFEQT-OS score as independent predictors of worsening health status, regardless of treatment strategy. Conclusion: Many patients with early AF experience worsening or no change in health status irrespective of treatment strategy. Standardizing patients’ health status assessment, especially for patients with comorbidities, may aid in patients’ selection and their outcomes.

  • Factors Associated With Coronary Angiography Performed Within 6 Months of Randomization to the Conservative Strategy in the ISCHEMIA Trial

    Pracoń R., Spertus J.A., Broderick S., Bangalore S., Rockhold F.W., Ruzyllo W., Demchenko E., Nageh T., Grossman G.B., Mavromatis K., Manjunath C.N., Smanio P.E.P., Stone G.W., Mancini G.B.J., Boden W.E., Newman J.D., Reynolds H.R., Hochman J.S., Maron D.J., Doan J., Linefsky J., Lee R., Patel R., Miller T., Cho S.Y., Milbrandt S., Shelstad D., Banerjee S., Kamath P., Tejani I., Donnino R.M., Phillips L.M., Saric M., Abdul-Nour K., Schley A., Golden H., Stone P.H., Osseni H., Wiyarand C., Douglass P., Pomeroy H., Craft A., Harvey B., Jang J.J., Anaya O., Yee G., Goold P., Weitz S., Giovannone S., Pritchard L., Arnold S., Gans R., O'Keefe J.H., Kennedy P., Shapiro M.D., Ganesan S., Schlichting D., Naher A., Fein S.A., Stewart W.L., Torosoff M.T., Salmi K.M., Lyubarova R., Mookherjee S., Drzymalski K., McFalls E.O., Garcia S.A., Bertog S.C., Johnson D.K., Siddiqui R.A., Herrmann R.R., Ishani A., Hansen R.A., Khouri M.G., Arges K., LeFevre M., Tomfohr J., Goldberg J.L., Byrne K.A., Zappernick T., Goldweit R., Canada S., Kakade M., Mieses P., Cohen R.A., Mirrer B., Navarro V., Rantinella M., Rodriguez J., Mancilla O., Winchester D.E., Stinson S., Kronenberg M., Weyand T., Rogal P.

    Circulation: Cardiovascular Interventions 17 ( 6 ) 457 - 473 2024.06

    ISSN  19417640

    　View Summary

    BACKGROUND: ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) did not find an overall reduction in cardiovascular events with an initial invasive versus conservative management strategy in chronic coronary disease; however, there were conservative strategy participants who underwent invasive coronary angiography early postrandomization (within 6 months). Identifying factors associated with angiography in conservative strategy participants will inform clinical decision-making in patients with chronic coronary disease. METHODS: Factors independently associated with angiography performed within 6 months of randomization were identified using Fine and Gray proportional subdistribution hazard models, including demographics, region of randomization, medical history, risk factor control, symptoms, ischemia severity, coronary anatomy based on protocol-mandated coronary computed tomography angiography, and medication use. RESULTS: Among 2591 conservative strategy participants, angiography within 6 months of randomization occurred in 8.7% (4.7% for a suspected primary end point event, 1.6% for persistent symptoms, and 2.6% due to protocol nonadherence) and was associated with the following baseline characteristics: enrollment in Europe versus Asia (hazard ratio [HR], 1.81 [95% CI, 1.14-2.86]), daily and weekly versus no angina (HR, 5.97 [95% CI, 2.78-12.86] and 2.63 [95% CI, 1.51-4.58], respectively), poor to fair versus good to excellent health status (HR, 2.02 [95% CI, 1.23-3.32]) assessed with Seattle Angina Questionnaire, and new/more frequent angina prerandomization (HR, 1.80 [95% CI, 1.34-2.40]). Baseline low-density lipoprotein cholesterol <70 mg/dL was associated with a lower risk of angiography (HR, 0.65 [95% CI, 0.46-0.91) but not baseline ischemia severity nor the presence of multivessel or proximal left anterior descending artery stenosis >70% on coronary computed tomography angiography. CONCLUSIONS: Among ISCHEMIA participants randomized to the conservative strategy, angiography within 6 months of randomization was performed in <10% of patients. It was associated with frequent or increasing baseline angina and poor quality of life but not with objective markers of disease severity. Well-controlled baseline low-density lipoprotein cholesterol was associated with a reduced likelihood of angiography. These findings point to the importance of a comprehensive assessment of symptoms and a review of guideline-directed medical therapy goals when deciding the initial treatment strategy for chronic coronary disease. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522. GRAPHIC ABSTRACT: A graphic abstract is available for this article.

  • Patient concern regarding bleeding side effects from oral anticoagulation therapy for atrial fibrillation: an analysis from the multicentre KiCS-AF registry

    Ueda I., Kohsaka S., Ikemura N., Kimura T., Katsumata Y., Takemura R., Suzuki M., Takatsuki S., Koide D., Fukuda K.

    European Journal of Cardiovascular Nursing 23 ( 4 ) 358 - 366 2024.05

    ISSN  14745151

    　View Summary

    Aims: The purpose of this study is to utilize patient-reported outcomes to determine the percentage of patients concerned about mild to moderate bleeding side effects of anticoagulants. Methods and results: We consecutively enrolled 3312 newly diagnosed or referred patients for atrial fibrillation (AF) management from 11 sites within the Keio interhospital Cardiovascular Studies-Atrial Fibrillation registry between September 2012 and May 2018. Of these patients, 2636 (79.5%) were taking oral anticoagulants at enrollment. Using the Atrial Fibrillation Effect on Quality-of-life questionnaire (AFEQT), the patients who responded '1: not at all bothered' or '2: hardly bothered' on the seven-point scale regarding bleeding side effects were classified as the 'no OAC concern' group while those responding '3: a little bothered' to '7: extremely bothered' were classified as the 'OAC concern' group. On baseline analysis, 29.3% (n = 772) were 'concerned' about bleeding side effects. The proportion of women and patients with AF-related symptoms was higher in the oral anticoagulant (OAC) concern vs. no OAC concern group (36.9% vs. 29.8%, P < 0.0004 and 66.2% vs. 56.7%, P < 0.0001, respectively). The CHADS2 scores ≥ 2 were comparable between groups. Of the 430 patients in the 1-year follow-up analysis, the proportion of the continued OAC concern group (1 year from enrollment) was 41.6%. The dabigatran, rivaroxaban, and apixaban usage rates were comparable between the two groups in baseline and 1-year follow-up analysis. Conclusion: Approximately one-third of all patients with AF on anticoagulant therapy were concerned regarding bleeding from short- and long-term anticoagulant use.

  • Physician Estimates and Patient-Reported Health Status in Atrial Fibrillation

    Ikemura N., Kohsaka S., Kimura T., Jones P.G., Katsumata Y., Tanimoto K., Ueda I., Takatsuki S., Ieda M., Chan P.S., Spertus J.A.

    JAMA Network Open 7 ( 2 )  2024.02

    　View Summary

    Importance: A primary objective in managing atrial fibrillation (AF) is to optimize patients' health status, which can be done only if physicians accurately quantify the outcomes associated with AF in patients' lives. Objective: To explore physicians' estimation of the health status of patients with AF and its association with subsequent care and outcomes. Design, Setting, and Participants: A multicenter, prospective cohort study was conducted in 2 outpatient practices in Tokyo, Japan. Participants included patients with newly diagnosed AF or those referred for initial treatment of AF at outpatient practices and treating physicians from November 8, 2018, to April 1, 2020. Data analysis was performed from December 22, 2022, to July 7, 2023. Exposures: Participating patients completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire, a 20-item tool covering 4 domains with a 7-point Likert scale; 3 domains (symptoms, daily activities, and treatment concerns) were used in this study. Blinded to patients' responses, treating physicians answered a 3-item questionnaire quantifying each patient's AFEQT domain with a single item. Patients' mean Likert scale responses within each AFEQT domain were subtracted from the physicians' assessments so that higher scores (≥0.5 points) indicate physician underestimation, while lower scores (≤0.5 points) indicate physician overestimation of the health status of patients with AF. Main Outcomes and Measures: The independent association of physician-patient concordance with treatment escalation (alteration or initiation of antiarrhythmic drugs, cardioversion, or catheter ablation) and 1-year adjusted changes in AFEQT scores. Results: Among 330 patients (238 [72.1%] men; mean [SD] age, 67.9 [11.9] years; 163 [49.4%] with paroxysmal AF), physicians correctly estimated health status in 112 patients (33.9%), underestimated it in 42 patients (12.7%), and overestimated it in 176 patients (53.3%). Treatment escalation occurred in 63.6% of patients whose health status was correctly estimated, 47.6% of those whose health status was underestimated, and 66.3% of patients whose health status was overestimated. After multivariable adjustment, underestimation of health status was independently associated with less treatment escalation (adjusted odds ratio, 0.43; 95% CI, 0.20-0.90) and less frequent AFEQT overall summary score improvement at 1 year (underestimated, 2.5 [95% CI, -1.6 to 6.7] vs correctly and overestimated health status, 8.4 [95% CI, 7.0-9.9] points; P =.01). Conclusions and Relevance: In this cohort study, physician underestimation of the health status of patients with AF was common and associated with less aggressive treatment and less health status improvement at 1 year..

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Papers, etc., Registered in KOARA 【 Display / hide 】

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Reviews, Commentaries, etc. 【 Display / hide 】

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Presentations 【 Display / hide 】

  • 「Constructing a Successful Multicenter Registry in Japan: Overcoming the Hurdles with Internet Technology and Skilled CRCs」

    Ueda Ikuko

    2014.03
    , 

    Symposium, workshop panel (public)

  • 医師主導臨床研究の具体例から研究者と研究組織（ARO）を考える「医師主導型臨床研究の実現を目指したCRCの取組み」

    Ueda Ikuko

    2012.11
    , 

    Symposium, workshop panel (nominated)

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Research Projects of Competitive Funds, etc. 【 Display / hide 】

  • 心房細動患者に対する抗凝固療法による消化管出血性合併症の臨床像と重症度同定

    2021.04
    -
    2024.03

    MEXT,JSPS, Grant-in-Aid for Scientific Research, Grant-in-Aid for Scientific Research (C), Principal investigator

  • 冠動脈ステント留置術後の抗血栓療法中における下部消化管出血臨床像とその発症率同定

    2018.04
    -
    2021.03

    MEXT,JSPS, Grant-in-Aid for Scientific Research, Grant-in-Aid for Scientific Research (C), Principal investigator

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Awards 【 Display / hide 】

  • 日本循環器学会第87回学術総会(2023年)コメディカル部門奨励賞

    植田育子, 2023.03, 「虚血性心疾患患者における冠動脈ステント留置後の上部ならびに下部消化管出血発症率とその 患者背景」

    Type of Award： Award from Japanese society, conference, symposium, etc.

  • 日本薬剤疫学会第23回学術総会(2017年) 奨励賞

    植田育子, 2017.11, 「抗凝固薬に対する出血への不安をベースにした心房細動患者背景の検討」

    Type of Award： Award from Japanese society, conference, symposium, etc.

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