Macau Heart Failure Study

Objective:To systematically evaluate the epidemiological characteristics,epidemiological characteristics,clinical features,treatment and prognosis of patients with acute heart failure(AHF),and to explore the burden of most important risk factors that affect the survival of patients with AHF in Macao.Methods:This study is a retrospective cohort study.The Macao Heart Failure Study consists of patients hospitalized with a diagnosis of acute heart failure(AHF)according to ICD-9 criteria at Centro Hospitalar Conde de Sao Januario(the only public hospital that provides medical care for the approximately 600,000 residents of Macao)from January 2014 to December 2016.We collected demographic information,clinical data,echocardiography,and laboratory results,treatments outcomes during hospitalization and follow-up(30 days,1 year,3 years,and 5 years).We made the systemic evaluation of Macao HF patients according to the following aspects:(1)Overall description of the epidemiological characteristics,treatments and prognosis of AHF patients in Macao,and comparison with representative heart failure registration research data in China Mainland and other developed countries in the world;(2)The clinical characteristics,treatment and prognosis of HF patients in different age groups in Macao;(3)Focusing on the clinical characteristics,treatment status and prognosis of patients with HFpEF in Macao.Results::A total of 967 patients were included in the final analysis.The median age at admission was 82 years old.which was about 10 years older than the average age(70-73 years)of other developed regions in the world,and was 16 years older than average admitted age in China Mainland.The advanced age at the admission of HF in Macao was significantly associated with a high-income level and the aging population structure(P<0.01).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(P<0.01).Compared with heart failure with reduced ejection fraction(HFrEF),the prevalence of HFpEF is gradually increasing,and patients with HFpEF were more likely to be older,female and to have a history of hypertension,atrial fibrillation.anemia and previous heart failure.the adjust all-cause mortality,cardiovascular mortality and re-admission rate at lyear,3 years and 5 years were not significantly different in the two groups(P>0.05).Conclusion:Macao Heart Failure Study first filled the gap in the field of heart failure in Macao.The aging population and the high prevalence of HFpEF have become great health burdens in Chinese population in Macao.Macao Heart Failure registry(Macao-HF)may significantly improve our understanding of this epidemical trends and provide an important source of data shaping both public policy and research efforts in Macao.Moreover,based on the lessons learned from Macao-HF,we also propose a roadmap for the design and conduct of future hospitalize heart failure registries in China.Part ? Macao Heart Failure Study-Epidemiological Characteristics,Clinical Features,Treatments and PrognosisObjective:To systematically evaluate the clinical features,current treatment status and prognosis of the prescribed patients with acute heart failure in Macao.Methods:We consecutively enrolled patients hospitalized with a diagnosis of acute heart failure(AHF)at Centro Hospitalar Conde de Sao Januario in Macao from 2014.1.1 to 2016.12.31.We collected demographic and clinical information,echocardiographic data,and laboratory tests results,treatments and outcomes during hospitalization and follow-up.The main outcome measures were all-cause death,cardiovascular death,re-admission and re-admission due to heart failure at 30 days,1 year,3 years and 5 years post discharge.Results:The average age of 967 patients with AHF included in the Macao-HF study was 82.0±12.5 years,which was about 10 years older than of other developed regions(70-73 years)in the world,and was older than that in China Mainland(66.0±15.0 years old)about 16 years.The proportion of male was 49.8%.The main cause of heart failure is ischemic cardiomyopathy(42.9%),followed by hypertensive heart disease(25.2%).The most common triggers of AHF are myocardial ischemia(32.2%)and infection(19.8%),followed by various acute arrhythmias(17.5%).85%of patients have hypertension,47.2%have diabetes,nearly one-third have atrial fibrillation/flutter and renal insufficiency,and 59.9%have anemia.The evidence-based medicines recommended by the guidelines were used in less than 60%in Macao.The absolute mortality rate in Macao was significantly high.Multivariate Cox regression analysis suggested that age,stroke,diabetes,renal insufficiency,atrial fibrillation/flutter,and hyponatremia were independent risk factors affecting their prognosis.Conclusion:Macao's AHF patients present advanced age and many comorbidities.The Application of evidence-based medicines in Macao AHF patients were significantly insufficiency at admission.Absolute mortality rates were very high both during hospitalization and follow up,which have become a great challenge to public health in Macao.Part ? The Aging Burden of Hospitalization for Heart Failure in Chinese Populations:Evidence from the Macao Heart Failure StudyObjective: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 Sao Januario(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 patients' 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.Part ? Comparing the Clinical Features,Treatment and Prognosis of Acute Heart Failure with Preserved Ejection Fraction and Reduced Ejection Fraction in MacaoObjective:The importance of heart failure with preserved ejection fraction is increasingly recognized.We conducted a study to systematically evaluate the clinical features,treatments and outcomes of patients with heart failure with preserved ejection fraction and to compare these findings with those from patients with heart failure with reduced ejection fraction.Methods:from January 1,2014,through December 31,2016,we enrolled 967 patients hospitalized with a diagnosis of acute heart failure(AHF)at Centro Hospitalar Conde de Sao Januario in Macao whose ejection fraction had also been assessed.The patients were categorized in three groups according to the left ventricular ejection fraction(LVEF)estimated by echocardiography at admission:heart failure with reduced ejection fraction group(HFrEF,LVEF<40%),heart failure with mid-range ejection fraction group(HFmrEF,LVEF 40-50%),and heart failure with preserved ejection fraction group(HFpEF,LVEF? 50%).We compared the details regarding to the clinical features,treatments and different outcomes between HFrEF and HFpEF groups.The main outcome measures were all-cause death,cardiovascular death,re-admission and re-admission due to heart failure at 30 days,1 year,3 years and 5 years post discharge.Results:HFpEF patients accounted for 52.8%and had an LVEF of more than 50%and 32.8%of patients had an LVEF of less than 40%.Patients with HFpEF were more likely to be older,female and to have a history of hypertension,atrial fibrillation,anemia and previous heart failure.The un-adjust all-cause mortality,cardiovascular mortality and re-admission rate at lyear,3 years and 5 years in HFpEF groups were significantly higher than those with HFrEF(P<0.05);the adjust all-cause mortality,cardiovascular mortality and re-admission rate at 1year,3 years and 5 years were not significantly different in the two groups(P>0.05).The absolute risk of mortality rate was as high as 41.8%,52.1%and 55.3%at 1 years,3 years and 5 years.respectively.Advanced age was the common predictor of all-cause mortality and cardiovascular mortality in two groups.For patients with HFpEF,stroke and atrial fibrillation were independent risk factors of 1 year,3 years and 5 years all-cause mortality and cardiovascular mortality.Conclusion:Among patients hospitalized for heart failure in Chinese population in Macao,a substantial proportion had an ejection fraction of more than 50%.The survival and readmission rate at short-,mid-and long-term of patients with HFpEF was similar to those of patients with HFrEF.However,a high absolute mortality rate in patients with HFpEF underscore the importance of this growing public health problem.