[Contemporary epidemiology and treatment of hospitalized heart failure patients in real clinical practice in China].

Objective: To observe the etiology, comorbidities, clinical features and treatment patterns of hospitalized patients with heart failure (HF) in China. Methods: Data were collected prospectively on hospitalized patients with HF who were enrolled in China Heart Failure Center Registry Study from 169 participating hospitals from January 2017 to August 2018. In this cross-sectional study, patients were stratified by left ventricular ejection fraction (LVEF) category: heart failure with reduced ejection fraction (HFrEF, LVEF<40%); heart failure with mid-ranged ejection fraction (HFmrEF, 40%≤LVEF<50%) and heart failure with preserved ejection fraction (HFpEF, LVEF≥50%). The clinical data were collected, including demographic information, diagnosis, signs, electrocardiogram, echocardiography, laboratory tests, and treatment. Results: A total of 31 356 hospitalized patients with HF were included, 19 072 (60.8%) were males and the average age was (67.9±13.6) years old. The common causes of HF were hypertension (57.2%), coronary heart disease (54.6%), dilated cardiomyopathy (14.7%), valvular heart disease (9.2%). The common complications were atrial fibrillation/atrial flutter (34.1%), diabetes (29.2%), and anemia (26.7%). 32.8% of patients had a history of hospitalization for HF within the previous 12 months. There were 11 034 (35.2%) patients with HFrEF, 6 825 (21.8%) patients with HFmrEF and 13 497 (43.0%) patients with HFpEF. Compared with patients with HFpEF, patients with HFrEF had a lower systolic blood pressure ((124.7±21.1)mmHg(1 mmHg=0.133 kPa) vs. (134.9±22.9)mmHg), faster heart rate ((85±19) beats/minutes vs. (81±19)beats/minutes), and higher percentage of New York Heart Association (NYHA) class Ⅳ, smoking, alcohol, left bundle branch block, and QRS time≥130 ms, and higher levels of blood uric acid, BNP, and NT-proBNP (all P<0.05). Compared with patients with HFmrEF and HFrEF, patients with HFpEF were older, more women, and higher comorbidity burden including hypertension, atrial fibrillation/atrial flutter, anemia and chronic obstructive pulmonary disease (all P<0.05). HFmrEF took a mid-position between HFrEF and HFpEF in age, gender, heart rate, systolic blood pressure, hypertension, atrial fibrillation/atrial flutter, anemia, and chronic obstructive pulmonary disease (all P<0.05). Patients with HFmrEF had the highest proportion of coronary heart disease, myocardial infarction and percutaneous coronary intervention (all P<0.05). During hospitalization, loop diuretics were used in 90.2% of patients, and intravenous inotropics were used in 20.4% of patients. The use of ACEI/ARB/ARNI, β blockers and aldosterone receptor antagonists at discharge were 71.8%, 79.1% and 83.6% in HFrEF and 69.9%, 75.5% and 72.4% in HFmrEF, respectively. The use of digoxin at discharge was 25.3% (HFrEF 36.7%, HFmrEF 23.1%, HFpEF 17.0%). The rates of cardiac resynchronization therapy and implantable cardioverter defibrillator in HFrEF were 2.7% and 2.1%. Conclusions: Among the hospitalized patients with HF in China, coronary heart disease and hypertension are the mostly prevalent causes. HFpEF accounts for a large proportion of hospitalized patients with HF. HFrEF, HFmrEF and HFpEF have different etiology and clinical features. In real-world, there are still large gaps in the effective application of the guideline recommended therapies to HF patients, especially the non-pharmacological therapy option, which needs to be improved further in China.目的： 调查并总结我国住院心力衰竭（心衰）患者的病因、合并症、临床特点和治疗情况。 方法： 本研究数据来源于中国心衰中心注册研究，该研究前瞻性入选了2017年1月至2018年8月169家医院的心衰患者。本研究为横断面调查，入选中国心衰中心注册研究中的住院心衰患者，根据左心室射血分数（LVEF）水平分组，分为射血分数降低的心衰（HFrEF）组（LVEF<40%）、射血分数中间值的心衰（HFmrEF）组（40%≤LVEF<50%）和射血分数保留的心衰（HFpEF）组（LVEF≥50%）。收集入选患者的临床资料，包括人口学信息、诊断、体征、心电图、超声心动图、实验室指标和治疗等。 结果： 本研究最终纳入住院心衰患者31 356例，其中男性19 072例（60.8%），年龄（67.9±13.6）岁。住院心衰患者的常见病因为冠心病（54.6%）、高血压（57.2%）、扩张型心肌病（14.7%）、瓣膜性心脏病（9.2%），常见合并症为心房颤动（房颤）/心房扑动（房扑）（34.1%）、糖尿病（29.2%）、贫血（26.7%）。心衰患者近1年内因心衰住院的比例为32.8%。HFrEF组患者共11 034例（35.2%），HFmrEF组患者共6 825例（21.8%），HFpEF组患者共13 497例（43.0%）。与HFpEF组比较，HFrEF组患者收缩压较低、心率较快（P均<0.05），纽约心脏协会（NYHA）心功能Ⅳ级、吸烟、饮酒、左束支传导阻滞及QRS时限≥130 ms的比例较高（P均<0.05），血尿酸、B型利钠肽及N末端B型利钠肽原水平较高（P均<0.05）。与HFmrEF组和HFrEF组比较，HFpEF组患者年龄较大，女性较多，合并高血压、房颤/房扑、贫血及慢性阻塞性肺疾病的比例较高（P均<0.05）。HFmrEF患者的年龄、女性比例、心率、收缩压以及合并高血压、房颤/房扑、贫血、慢性阻塞性肺疾病的比例均介于HFrEF与HFpEF之间。HFmrEF患者中冠心病、心肌梗死和接受冠状动脉介入治疗的比例均较其他两组高（P均<0.05）。住院期间，襻利尿剂的使用率为90.2%，静脉正性肌力药物的使用率为20.4%。出院时，血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂、β受体阻滞剂和醛固酮受体拮抗剂的使用率，在HFrEF组患者中分别为78.2%、79.1%和83.6%，在HFmrEF组患者中分别为72.6%、75.5%和72.4%。心衰患者出院时地高辛使用率为25.3%（HFrEF组为36.7%，HFmrEF组为23.1%，HFpEF组为17.0%）。HFrEF组患者心脏再同步治疗、植入式心脏复律除颤器植入率分别为2.7%和2.1%。 结论： 我国住院心衰患者中HFpEF患者占比较大，主要病因为冠心病和高血压。HFrEF、HFmrEF、HFpEF患者的病因、合并症和临床特征有所不同。真实世界中心衰患者的治疗现状与指南推荐差距较大，尤其是在非药物治疗方面，需改进。.