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The burden and management competency of cardiomyopathies in China: a nationwide survey study
Yu Zhang1, Minghao Liu2, Peijin Li1
1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Cardiomyopathy cases rose in China from 2017-2021, yet advanced care remains limited. Significant disparities exist in hospital management capabilities, highlighting a need for resource reallocation.
Area of Science:
- Cardiology
- Public Health
- Health Systems Research
Background:
- The public health impact of cardiomyopathies in China is not well understood.
- Assessing the management capabilities of Chinese health agencies for cardiomyopathies is crucial.
Purpose of the Study:
- To evaluate the trends in cardiomyopathy (CMP) visits and assess the management competency of tertiary hospitals in China.
- To identify disparities in CMP care across different hospital levels and regions.
Main Methods:
- A multi-stage sampling method was used to select 66 hospitals across China.
- Data on outpatient and inpatient visits for cardiomyopathies (2017-2021) and hospital management competency were collected.
- A specialized scale evaluated hospital competency in providing cardiomyopathy care.
Main Results:
- Cardiomyopathy outpatient and inpatient visits increased by 38.6% and 33.0% respectively from 2017-2021.
- While basic assessment facilities are common, advanced procedures and integrated care pathways are limited.
- Only 6.1% of hospitals met criteria for comprehensive centers, and 43.9% for primary centers, with significant competency variations.
Conclusions:
- The health burden of cardiomyopathies has significantly increased in China.
- Tertiary hospitals offer basic care, but advanced facilities and integrated management need improvement.
- Disparities in management competency necessitate a review of medical resource allocation.
Background:
The public health burden of cardiomyopathies and competency in their management by health agencies in China are not well understood.
Methods:
This study adopted a multi-stage sampling method for hospital selection. In the first stage, nationwide tertiary hospital recruitment was performed. As a result, 88 hospitals with the consent of the director of cardiology and access to an established electronic medical records system, were recruited. In the second stage, we sampled 66 hospitals within each geographic-economic stratification through a random sampling process. Data on (1) the outpatient and inpatient visits for cardiomyopathies between 2017 and 2021 and (2) the competency in the management of patients with cardiomyopathies, were collected. The competency of a hospital to provide cardiomyopathy care was evaluated using a specifically devised scale.
Findings:
The outpatient and inpatient visits for cardiomyopathies increased between 2017 and 2021 by 38.6% and 33.0%, respectively. Most hospitals had basic facilities for cardiomyopathy assessment. However, access to more complex procedures was limited, and the integrated management pathway needs improvement. Only 4 (6.1%) of the 66 participating hospitals met the criteria for being designated as a comprehensive cardiomyopathy center, and only 29 (43.9%) could be classified as a primary cardiomyopathy center. There were significant variations in competency between hospitals with different administrative and economic levels.
Interpretation:
The health burden of cardiomyopathies has increased significantly between 2017 and 2021 in China. Although most tertiary hospitals in China can offer basic cardiomyopathy care, more advanced facilities are not yet universally available. Moreover, inconsistencies in the management of cardiomyopathies across hospitals due to differing administrative and economic levels warrants a review of the nation allocation of medical resources.
Funding:
This work was supported by the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (2023-I2M-1-001) and the National High Level Hospital Clinical Research Funding (2022-GSP-GG-17).
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