Epidemiological Trends, Etiology, and Burden Study of Heart Failure in China, 1990–2019

Background: Despite the enormous impact of heart failure (HF) in China, there is a relative lack of research on its epidemiologic trends and burden. Therefore, there is an urgent need for a comprehensive and in-depth analysis of the epidemiologic patterns, underlying etiology, and overall burden of HF.

Objective: This study aimed to elucidate the epidemiology, etiology, and burden of HF in China and provided a comprehensive and up-to-date analysis, including temporal trends from 1900 to 2019.

Methods: The data for this study were derived from the Global Burden of Disease (GBD) study 2019. Descriptive analyses were conducted to examine the prevalence and years lived with disability (YLD) rates in China from 1990 to 2019, with variables including year, sex, and age. To illustrate the temporal trend spanning 1990 to 2019, estimated average annual percentage changes (AAPC) were calculated.

Results: In 2019, the number of prevalent HF cases in China was 18.51 million (95% uncertainty interval [UI]: 14.97 to 23.02 million), representing 32.9% of the global prevalence. Between 1990 and 2019, the number of cases and the prevalence rates of HF in China showed an increasing trend. The age-standardized prevalence rates (ASPRs) demonstrated an overall declining trend (AAPC = −0.16, 95% confidence interval [CI]: −0.19 to −0.13, p < 0.01), as did the age-standardized YLD rates (AAPC = −0.13, 95% CI: −0.16 to −0.1, p < 0.01). However, from 2017 to 2019, a gradual increase was observed (AAPC = 1.72, 95% CI: 1.47 to 1.96, p < 0.01). In the age-based analysis, individuals aged 55 years and older accounted for 88.3% of the prevalent cases. Women exhibited higher case numbers and ASPR compared to men. In the cause-based analysis, hypertensive heart disease emerged as the primary etiology of HF in China.

Conclusion: From 1990 to 2019, the ASPR and age-standardized YLD rates for HF in China demonstrated an overall decreasing trend. Nevertheless, the trend increased from 2017 to 2019, with significant variations observed by gender and age. Therefore, continued attention to the disease burden of HF in China remains essential. Healthy lifestyles are important for minimizing the prevalence of HF. In addition, it is necessary to address and reduce the incidence of hypertension from all causes to mitigate the disease burden further.