Retrospective investigation of hospitalized patients with heart failure in some parts of China in 1980, 1990 and 2000

Objective To evaluate the current status of heart failure in some parts of China and analyze the epidemiological evolution of its general condition,etiology,pharmaceutical therapy, outcome and mortality,and provide information on the prevention and treatment strategy of heart failure in China Methods Data on primary diagnosis of chronic heart failure were taken from 42 hospitals in different cities of China All patients were admitted to hospital in 1980, 1990 and 2000 Results (1) A total of 10 714 patients with heart failure were enrolled The majority (56 7%) were males and the average age was( 63 1±16 1)years to (67 8±16 5)years More than 60% were older than 60 years (2)The courses of the heart failure in 1980,1990 and 2000 were (128 9±125 7)months,(88 1±98 6)months and (46 6±77 4)months ( P 0 001), respectively,and in hospital durations were (35 1±43 0) days,(31 6±34 1) days, (21 8±25 6) days( P 0 001), respectively,with the trend of decreasing year by year (3) Common causes of heart failure were coronary heart disease, rheumatic valvular heart disease and hypertension From 1980 to 2000,the rate of coronary heart disease and hypertension rose from 36 8% and 8 0% to 45 6% and 12 9%, respectively Meanwhile the rate of rheumatic valvular heart disease fell from 34 4% to 18 6%(all P 0 001 ) (4)The most patients′ heart functions before hospitalization of all the three years were graded as level Ⅲ (42 5%-43 7%),and patients with heart function of level Ⅱ increased year by year(24 5%, 26 7%, 27 7%, respectively); by contrast the patients of level Ⅳ heart function reduced at the same time (32 4%, 28 8%, 27 5%) (5)There was no distinct difference of the rate of thoracic X ray examination and the abnormal heart thoracic ratio among the three years; but proportion of UCG examination and the patients with low LVEF increased year by year,being 27 6%, 40 5%, 47 5%( P 0 001)and 40 1%, 45 0%, 53 5%( P 0 001), respectively (6)The diuretics, nitride and digitalis still dominated the drug therapy in hospital, with the total proportion of 55 4%, 43 2%, 48 2%, respectively The proportion of patients receiving digitalis decreased (51 7%, 45 5%, 40 3%);and the users of β blocker and ACEI increased from 8 5% and 14 0% in 1980 to 19 0% and 40 4% in 2000, respectively (7)The heart failure were obviously corrected during hospitalization, the improvement rate being 15 5%, 19 6% and 22 2% ( P 0 001), respectively, with significantly decreased mortality of 15 4%, 12 3%, 6 2%( P 0 001),but still higher than that of whole cardiac diseases at the same period (8 2%, 5 6% and 2 6% in the three years, respectively) The proportion of heart failure mortality to the whole cardiac deaths still remained unchanged (39 9%,37 7%,41 1%, respectively) (8)The causes of the heart failure were pump failure(59%),arrhythmia (13%),sudden death (13%), and others (14%) in turn Conclusions There was no decrease in the proportion of heart failure to the whole cardiac diseases hospitalized patients The primary diseases causing heart failure in the hospitalized patients shifted from the rheumatic heart disease to the coronary heart disease, and the conventional drugs still dominate the medical therapy for the heart failure, but the use of β blocker and ACEI increased significantly Although the mortality of heart failure decreased, the proportion of it to cardiac diseases mortality kept unchanged