Recently, a research conducted by Zhang Jian's team at Fuwai Hospital, Chinese Academy of Medical Sciences showed that compared with the Phase I study of China Heart Failure Registration (2012-2015), the Phase II study of China Heart Failure Registration showed that the quality of heart failure in China has improved, reflecting the specific clinical characteristics and great progress of medical and device treatment guided by guideline-oriented medical and device treatment in adult heart failure patients in China. The
phase I study included 13,687 patients, and the phase II registration study included data from 113 hospitals from 2017 to 2020, including 87 tertiary hospitals, and 26 non-tertiary hospitals. In the
phase II study, 40.2% were heart failure patients with reduced ejaculation fraction of , 21.8% were heart failure (HFmrEF) with intermediate ejaculation fraction (HFmrEF), and 38.0% were heart failure (HFpEF) with retained ejaculation fraction. Left ventricular function and natriuretic peptide detection were detected in 93.7% and 93.0% of patients, respectively.
Compared with American patients, Chinese patients with heart failure are (67±14) years old and American patients (72±15) years old. Chinese patients have lower systolic blood pressure and body mass index, and the prevalence of hypertension , diabetes , and atrial fibrillation is also lower. In terms of
treatment, in the Phase II study, 78.2% prescribed oral diuretics, 78.7% prescribed renin-angiotensin system inhibitors, and 82.2% prescribed beta blockers.
implantable cardiac rhythm reversal defibrillator (ICD) and cardiac resynchronization therapy (CRT) usage rates were 3.9% and 14.6%, respectively.
Figure 1 Guideline-oriented drug use for patients with HFrEF, HFmrEF or HFpEF in China-HF Phase II (2017-2020)
The overall compliance with standardized guidelines-oriented treatment in patients with heart failure is lower than the results of the American Heart Association’s “Follow the Guidelines— Heart Failure (GWTG-HF)” project from 2010-2016.
Figure 2 Comparison of China-HF Phase I (2012-2015), China-HF Phase II (2017-2020) and GWTG-HF Registration (2010-2016) in patients with discharged
was 87.8%, higher than in the United States.
The median hospital stay in patients with overall heart failure was 9 days, while in GWTG-HF was 4 days.
938 (2.8%) patients died or gave up treatment during hospitalization. The in-hospital mortality rate was similar to that of the United States, but was lower than 4.2% of the Phase I study.
study also found that in addition to the applications of digoxin and spironolide, the guidelines-oriented standardized drug treatment of non-tertiary hospitals are lower than those of tertiary hospitals, among which the application of ARNI is the most different.
Researchers pointed out that this difference may be caused by economic development, changes in medical insurance coverage, a lack of heart failure specialists, and a high proportion of high-risk patients in non-tertiary hospitals. The accurate identification, timely transfer and effective monitoring of heart failure patients in non-tertiary hospitals still need to be improved.
Figure 3 China-HF Phase II (2017-2020) The diagnosis and treatment situation of tertiary and non-tertiary hospitals in my country is relatively low. Researchers pointed out that it is necessary to do a work in understanding the indications of ICD/CRT treatment in non-tertiary hospitals, and promote referrals to suitable patients in non-tertiary hospitals to improve the rational treatment of ICD/CRT.
In this study, the China-HF registration study data from 2017 to 2020 included 34,938 hospitalized patients with heart failure from 113 hospitals, the China-HF registration study from 2012 to 2015 included 13,687 patients with heart failure, and the GWTG-HF program from 2010 to 2016 included 423,333 patients.
Source: Zhang Y, Gao C, Greene SJ, et al. Clinical performance and quality measures for heart failure management in China: the China-Heart Failure registry study. ESC Heart Fail. 2022 Oct 12.
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