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. 2023 Sep 20;30(13):1391-1400.
doi: 10.1093/eurjpc/zwad223.

Prevalence of heart failure stages in the general population and implications for heart failure prevention: reports from the China Hypertension Survey 2012-15

Anping Cai  1 , Congyi Zheng  2 , Jiayuan Qiu  3 , Gregg C Fonarow  4 , Gregory Y H Lip  5   6 , Yingqing Feng  1 , Zengwu Wang  2
Affiliations

Prevalence of heart failure stages in the general population and implications for heart failure prevention: reports from the China Hypertension Survey 2012-15

Anping Cai et al. Eur J Prev Cardiol. .

Abstract

Aims: There are no nationwide epidemiological data on heart failure (HF) stages in China. Knowledge of the prevalence of HF stages is crucial for planning HF prevention and management strategies. We aimed to evaluate the prevalence of HF stages in the general Chinese population and the specific prevalence by age, sex, and urbanity.

Methods and results: This is a cross-sectional study and national representative general population aged ≥ 35 years (n = 31 494, mean age 57.4 years, women 54.1%) were obtained from the China Hypertension Survey. Participants were divided into Stage A (at-risk for HF), Stage B (pre-HF), and Stage C (symptomatic HF). Survey weights were calculated based on the 2010 China population census data. The prevalence of Stage A was 35.8% (≈245.1 million), Stage B 42.8% (≈293.1 million), and Stage C 1.1% (≈7.5 million). The prevalence of Stages B and C increased with increasing age (P < 0.0001). Women had lower prevalence of Stage A (32.6% vs. 39.3%; P < 0.0001) but higher prevalence of Stage B (45.9% vs. 39.5%; P < 0.0001) than men. People from rural area had lower prevalence of Stage A (31.9% vs. 41.0%; P < 0.0001) but higher prevalence of Stage B (47.8% vs. 36.2%; P < 0.0001) than people from urban. The prevalence of Stage C was similar by sex and urbanity.

Conclusion: The burdens of pre-clinical and clinical HF are high and vary by age, sex, and urbanity in China. Targeted interventions are needed to reduce the high burden of pre-clinical and clinical HF.

Keywords: Heart failure; Prevalence; Risk factor; Structural heart disease.

Plain language summary

The burden of heart failure (HF) in China is projected to increase further with population ageing. In an effort to reduce the burden, a crucial starting point is to enhance our knowledge of the burden of clinical precursors of HF in the community. Heart failure can be divided into Stage A (at-risk for HF), Stage B (pre-HF), Stage C (symptomatic HF), and Stage D (advanced HF), which is helpful for early identifying people at risk for symptomatic HF and thus implementing interventions. Despite having a high HF burden, knowledge of the prevalence of HF stages in China is limited. We therefore used the data of China Hypertension Survey 2012–15 to evaluate the prevalence of HF stages in the general Chinese population and the specific prevalence by age, sex, and urbanity. Survey weights were calculated based on the 2010 China population census data. A total of 31 494 community-dwelling adults aged ≥ 35 years were included. The prevalence of Stage A was 35.8% (≈245.1 million), Stage B 42.8% (≈293.1 million), and Stage C 1.1% (≈7.5 million). The prevalence of Stages B and C increased with increasing age. Women had lower prevalence of Stage A but higher prevalence of Stage B than men. People from rural area had lower prevalence of Stage A but higher prevalence of Stage B than people from urban. The prevalence of Stage C was similar by sex and urbanity.The burdens of both pre-clinical and clinical HF are high in China.These burdens vary by age, sex, and urbanity.

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Conflict of interest statement

Conflict of interests: Dr Fonarow reports consulting for Abbott, Amgen, AstraZeneca, Bayer, Cytokinetics, Janssen, Medtronic, Merck, and Novartis. The other authors declare that they have no competing interests.

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