Characteristics, Management, and Outcomes of Patients Hospitalized for Heart Failure in China: The China PEACE Retrospective Heart Failure Study

Background Heart failure (HF) is an emerging epidemic in China and accounts for significant healthcare resource utilization in the inpatient setting. To create evidence-based, life-saving, and cost-saving hospitalization systems, the first step is to characterize the contemporary national landscape...

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Published in:Journal of the American Heart Association Vol. 8; no. 17; p. e012884
Main Authors: Yu, Yuan, Gupta, Aakriti, Wu, Chaoqun, Masoudi, Frederick A., Du, Xue, Zhang, Jian, Krumholz, Harlan M., Li, Jing
Format: Journal Article
Language:English
Published: England John Wiley and Sons Inc 03.09.2019
Wiley
Subjects:
acute heart failure
Adult
Aged
Aged, 80 and over
characteristics
China
China - epidemiology
Databases, Factual
Female
Heart Failure - diagnosis
Heart Failure - mortality
Heart Failure - physiopathology
Heart Failure - therapy
Hospital Mortality - trends
hospitalization
Hospitalization - trends
Humans
Length of Stay - trends
Male
Middle Aged
Original Research
outcomes
outcomes research
Patient Discharge - trends
Recovery of Function
Retrospective Studies
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
China
characteristics
hospitalization
outcomes
China
acute heart failure
outcomes research
quality of care
ISSN:2047-9980, 2047-9980
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Summary:Background Heart failure (HF) is an emerging epidemic in China and accounts for significant healthcare resource utilization in the inpatient setting. To create evidence-based, life-saving, and cost-saving hospitalization systems, the first step is to characterize the contemporary national landscape of inpatient HF care. Methods and Results In the China PEACE 5r-HF study (China Patient-centered evaluative Assessment of Cardiac Events Retrospective Study of Heart Failure), we used 2-stage random sampling to create a nationally representative cohort of 10 004 admissions for HF from 189 hospitals in 2015 in China. Data on patient characteristics, management, and outcomes were obtained through centralized medical record abstraction. The median age of the cohort was 73 years (interquartile range, 65-80), and 48.9% were women. More than half (56.2%) of the patients were hospitalized in rural areas. Prevalence of ejection fraction ≥50%, 40% to 50%, and <40% was 60.3%, 17.7%, and 22.0%, respectively. We identified substantial gaps in care, including underutilization of diagnostic tests such as echocardiograms (63.6%), chest imaging (75.2%), and biomarker testing (56.4%), low prescription rates of guideline-recommended medications during hospitalization and at discharge, suboptimal rates of follow-up appointments (24.3%), and widespread utilization of traditional Chinese medicine (74.8%). The combined rate of in-hospital mortality and treatment withdrawal in our study was 3.5%, and median length-of-stay was 9 days (interquartile range, 7-13). Conclusions Patients admitted with acute HF in China have distinctive epidemiology and receive substandard care, but have low inpatient mortality despite long length of stay. These findings provide opportunities for streamlining efficiencies while improving quality of inpatient HF care in China. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02877914.
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Dr Yu and Dr Gupta contributed equally to this work.
Dr Krumholz and Dr Li are joint senior authors.
A complete list of the China PEACE Collaborative Group members can be found in the Supplemental Material.
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.119.012884