The aging burden of hospitalization for heart failure in Chinese populations: evidence from the Macao Heart Failure Study

Abstract

Objective: To assess the aging burden of hospitalization for heart failure in Chinese populations in Macao.

Methods: The Macao Heart Failure Study consists of patients hospitalized with a diagnosis of acute heart failure (AHF) at Centro Hospitalar Conde de São Januário (the only public hospital that provides medical care for the approximately 600, 000 residents of Macao) from January 2014 to December 2016. First, we investigated the relationship between socioeconomic development and epidemiological characteristics of HF in Macao. Then we assessed the patientso clinical features and outcomes according to the age groups.

Results: A total of 967 patients were included in the final analysis. The median age at admission was 82 years old. The advanced age at the admission of HF in Macao was significantly associated with a high-income level and the aging population structure. Marked heterogeneity existed in the epidemiological characteristics, clinical features, utilization of evidence-based therapies, short- and long-term outcomes, and prognostic utility of clinical variables among the different age groups.

Conclusion: Rapid economic development and significantly aging populations have produced a profound impact on the epidemiological characteristics of HF in Chinese populations. Acute decompensated heart failure (ADHF) is predominantly a disease of the elderly in Macao, and a significant heterogeneity exists in the clinical features, managements, and outcomes among different age groups. Age-based risk stratification models and multidisciplinary HF teams are urgently needed to improve the management and outcomes of hospitalized heart failure (HHF) patients.

Keywords: Cardiac risk factors and prevention; Heart failure; The elderly.

1

The relationship between the median/average age admitted for heart failure and economic level (GDP per capita) and demographic structure (the degree of social aging measured by the percentage of the population aged 65 years or over)

2

The age distribution and hospitalization rate of acute heart failure by age and gender in Macao

3

Evidence-based medication utilization at admission and discharge

4

Kaplan-Meier survival curves and multivariate cox regression analyses for the prediction of risk of death according to the four age groups

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Adjusted hazard ratio (HR) forest plot of multivariate predictors of mortality in the four age groups at (A) 30 days, (B) 1 year, (C) 3 years, and (D) 5 years post-discharge