[Survey on the current status of hospitalized heart failure patients in China, 2023-2024]

Objective: To investigate the clinical characteristics, etiology distribution, comorbidities and treatment strategies of hospitalized patients with heart failure in China from 2023 to 2024. Methods: This was a cross-sectional study. Data were derived from the China Heart Failure Registry. Hospitalized patients with heart failure who participated in the registry between January 1, 2023 and December 31, 2024 were enrolled in this study. According to left ventricular ejection fraction, the enrolled patients were divided into three groups: heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). Clinical data of patients in each group were collected via a web-based online reporting system, including demographic data, causes of hospitalization, comorbidities, laboratory indicators, electrocardiography findings, echocardiography findings, and treatment strategies. Results: A total of 250 936 heart failure patients were enrolled, with an age of (70.1±13.2) years; among them, 105 338 (41.98%) were female. Specifically, 87 490 cases were diagnosed with HFrEF (34.87%), 53 473 with HFmrEF (21.31%), and 109 973 with HFpEF (43.83%). Coronary heart disease was the most common etiology (62.18%, 156 038/250 936), precipitating factor for hospitalization (49.36%, 123 863/250 936), and comorbidity (65.95%, 165 491/250 936) among hospitalized heart failure patients. Before discharge, the utilization rate of renin-angiotensin system inhibitors was 82.96% (72 578/87 490) in HFrEF patients. The utilization rates of beta-blockers and mineralocorticoid receptor antagonists were 84.77% (74 161/87 490) and 90.57% (79 238/87 490), respectively. The overall utilization rate of sodium-glucose cotransporter 2 inhibitors was 61.83% (155 143/250 936). Stratified by heart failure subtype, the utilization rates were 75.67% (66 195/87 490) in HFrEF patients, 64.31% (34 388/53 473) in HFmrEF patients, and 49.61% (54 560/109 973) in HFpEF patients, with lower rates in HFmrEF and HFpEF patients compared with HFrEF patients (P<0.001). The implantation rates of cardiac resynchronization therapy defibrillators, cardiac resynchronization therapy pacemakers, and implantable cardioverter defibrillators were 1.44% (1 262/87 490), 0.37% (323/87 490), and 1.35% (1 182/87 490), respectively, in HFrEF patients. The blood pressure control rate was 66.83% (8 822/13 201) in HFpEF patients under 60 years old. Among HFpEF patients complicated with coronary heart disease, the heart rate control rate was 36.46% (26 686/73 188). Conclusion: Among hospitalized patients with heart failure in China, HFpEF accounted for the largest proportion. Coronary heart disease was the most common etiology, the leading trigger for hospitalization, and the most prevalent comorbidity in this patient population. At discharge, the utilization rates of prognosis-improving medications remained high in HFrEF patients, whereas the application of device therapy was still insufficient. In HFpEF patients, the use of sodium-glucose cotransporter 2 inhibitors and the management of comorbidities remain areas in urgent need of optimizationin.