Mortality and recurrent events after first hospitalisation for heart failure and pulmonary heart disease: a community-based prospective study of 0.5 million Chinese adults

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Background Little is known about inequalities in prognosis of heart failure (HF) and pulmonary heart disease (PHD) in low-income and middle-income countries. The aims of this study were to compare hospitalisation and mortality rates between HF and PHD cases in Chinese adults. Methods In a prospective study of 512 724 adults from 10 areas in China Kadoorie Biobank enrolled in 2004–2008, data on first hospitalisations were obtained by linkage to hospitalisation and death registers. Outcomes included 28-day case-fatality ratio (CFR), 5-year cumulative mortality risks (CMR) and 5-year recurrent hospitalisations following first hospital admissions with HF or PHD. Results Among first incident hospitalisations with HF (n=7461) and PHD (n=5925), the hospitalisation rates (95% CI) for HF were 125 (122 to 128) and PHD were 99 (96 to 101) per 10 5 person-years. The hospitalisation rates for HF and PHD were greater in men than women (HF: 132 vs 120; PHD: 123 vs 80) and in rural than urban areas (HF: 130 vs 118; PHD: 165 vs 29). The 28-day CFRs were threefold greater for PHD than for HF (53% (95% CI 52% to 54%) vs 18% (17% to 19%)); the 28-day CFRs were higher for men than women (HF: 22 vs 18; PHD: 58 vs 46). The 5-year CMRs were 47% (35% to 58%) for HF and 70% (59% to 82%) for PHD; the 5-year CMRs were higher in men than women (HF: 55% vs 43%; PHD: 77% vs 62%). The 5-year recurrent hospitalisation risks for HF were 22% (95% CI 20% to 23%) and 34% (32% to 36%) for PHD. The recurrent hospitalisation risks for PHD were also higher in rural than urban areas (36% vs 24%). Conclusions Half of all first HF and three-quarters of first PHD cases died within 5 years, highlighting the urgent need to improve treatment for HF and PHD cases in China.

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