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Prognostic implications of heart failure stages among Chinese community populations: insight from a nationwide
Congyi Zheng1, Anping Cai2, Xin Wang1
1Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 102308, China.
Insights
Heart failure (HF) stages significantly increase mortality risk in Chinese adults. Early screening and interventions are crucial to mitigate the substantial burden of HF in China.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- High burden of heart failure (HF) in China necessitates studies on prognostic implications of HF stages.
- Understanding HF stage-specific mortality risk is crucial for Chinese community populations.
Purpose of the Study:
- To evaluate the association between heart failure (HF) stages and mortality risk.
- To assess the prognostic value of HF staging in a nationwide Chinese cohort.
Main Methods:
- Nationwide enrollment of 23,284 adults aged ≥35 years (2012-2016).
- Classification of participants into HF stages A, B, C, and an apparently-healthy group based on international guidelines.
- Multivariable-adjusted Cox proportional regression analysis to assess associations between HF stages and all-cause, cardiovascular (CV), and non-CV death.
Main Results:
- Advancing HF stages (A, B, C) were significantly associated with increased risks of all-cause, CV, and non-CV mortality compared to the apparently-healthy group.
- Hazard ratios for all-cause death increased progressively with HF stage: Stage A (1.90), Stage B (2.43), and Stage C (6.40).
- Heart failure stages A, B, and C accounted for a substantial population attributable fraction of deaths in China in 2018.
Conclusions:
- Progressive stages of heart failure are linked to escalating mortality risks.
- Urgent development and implementation of early screening and targeted interventions are needed to reduce the public health burden of HF in China.
Background:
In light of high burden of heart failure (HF) in China, studies of prognostic implication of HF stages are important. We aimed to evaluate the relationship between HF stages and mortality risk in Chinese community populations.
Methods:
Nationwide representative populations aged ≥35 years (n = 23,284, mean age 56.9 years, women 53.2%) were enrolled from 2012 to 2016. According to the international HF guidelines, participants were divided into stage A, B and C, and those who did not qualify these stages were categorized as apparently-healthy group. Association between HF stages and all-cause, cardiovascular [CV] and non-CV death was evaluated using multivariable-adjusted Cox proportional regression analysis.
Findings:
During a median follow-up of 4.7 years (109,902.8 person-years), 1314 deaths occurred. Age-adjusted incidence rate of all-cause death was 5.3 in apparently-healthy, 7.8 in stage A, 8.6 in stage B and 24.6 in stage C groups per 1000 person-years. In reference to apparently-healthy group, adjusted hazard ratio for all-cause death was 1.90 (95% CI: 1.47-2.45), 2.43 (95% CI: 1.89-3.13) and 6.40 (95% CI: 4.56-8.99) for stage A, B and C. Advancing HF stages were associated with increasing risks for all-cause, CV and non-CV death (P-trend <0.05). For all-cause death, population attributable fraction due to stage A, B and C were 21.2%, 33.4% and 4.9%, accounting for 1,933,385, 3,045,993 and 446,867 deaths in China in 2018.
Interpretation:
Advancing HF stages were associated with increasing risk mortality. Development and implementation of early screening and targeted interventions are urgently needed to reduce HF burdens in China.
Funding:
This work was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (grant 2017-I2M-1-004), the Projects in the Chinese National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (No.: 2011BAI11B01), and the Project Entrusted by the National Health Commission of the People's Republic of China (NHC2020-609).
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