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 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.

* based on the main functional ingredient.

Data S2 Definitions of in-hospital complications as provided in the caseabstraction forms 1) Deep venous thrombosis (DVT) or pulmonary embolism (PE)
Indicate evidence of DVT or PE was documented in the medical record, referring to the in-hospital development of DVT or PE. Pre-existing DVT or PE prior to admission should not be counted. The documentation of DVT or PE must be confirmed by ultrasound, venous imaging or appropriate diagnostic modality.

2) Myocardial infarction
Indicate if there is physician documentation of myocardial infarction during hospitalization. A myocardial infarction is evidenced by any of the following: 1. A rise and fall of cardiac biomarkers (preferably troponin) with at least one of the values in the abnormal range for that laboratory [typically above the 99th percentile of the upper reference limit (URL) for normal subjects] together with at least one of the following manifestations of myocardial ischemia: a. Ischemic symptoms. b. ECG changes indicative of new ischemia (new ST-T changes, new left bundle branch block, or loss of R wave voltage).
c. Development of pathological Q-waves in 2 or more contiguous leads in the ECG (or equivalent findings for true posterior MI).
d. Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality.
e. Documentation in the medical record of the diagnosis of acute myocardial infarction based on the cardiac biomarker pattern in the absence of any items enumerated in a-d due to conditions that may mask their appearance (e.g., perioperative infarct when the patient cannot report ischemic symptoms; baseline left bundle branch block or ventricular pacing).
2. Imaging evidence of a region with new loss of viable myocardium at rest in the absence of a non-ischemic cause. This can be manifest as: a. Echocardiographic, CT, MR, ventriculographic or nuclear imaging evidence of left ventricular thinning or scarring and failure to contract appropriately (i.e., hypokinesis, akinesis, or dyskinesis).
3. Medical record documentation of myocardial infarction.

3) Cardiogenic shock
Indicate if there is physician documentation of cardiogenic shock during hospitalization. Cardiogenic shock is defined as a sustained (>30 minutes) episode of systolic blood pressure <90 mm Hg, and/or cardiac index <2.2 L/min/m2 determined to be secondary to cardiac dysfunction, and/or the requirement for parenteral inotropic or vasopressor agents or mechanical support (e.g., intra-aortic balloon pump, extracorporeal circulation, ventricular assist devices) to maintain blood pressure and cardiac index above those specified levels.

4) Ischemic stroke
Indicate if there are physician documentations of new-onset ischemia stroke and strokerelated symptoms during hospitalization. The stroke-related symptoms include: trouble walking/loss of balance/incoordination, one-sided numbness or hemi-anesthesia, onesided facial numbness or hemi-anesthesia, mouth askew and drooling, dysarthria or slurred speech, loss of vision or blurred version in one or both eyes, dizziness with vomiting, severe headache and vomiting, unconsciousness, and hyperspasmia.

5) Hemorrhagic stroke
Indicate if there are physician documentations of new-onset hemorrhagic stroke and stroke-related symptoms during hospitalization.

6) Bleeding
Indicate if the patient had a bleeding event during hospitalization. Bleeding is defined as documented bleeding event or the drop in hemoglobin of ≥3 g/dL