Background: Large-scale and population-based studies of heart failure (HF) incidence and prevalence are scarce in China. The study sought to estimate the prevalence, incidence, and cost of HF in China. Methods: We conducted a population-based study using records of 50.0 million individuals ≥25 years old from the national urban employee basic medical insurance from 6 provinces in China in 2017. Incident cases were individuals with a diagnosis of HF (International Classification of Diseases code, and text of diagnosis) in 2017 with a 4-year disease-free period (2013–2016). We calculated standardized rates by applying age standardization to the 2010 Chinese census population. Results: The age-standardized prevalence and incidence were 1.10% (1.10% among men and women) and 275 per 100 000 person-years (287 among men and 261 among women), respectively, accounting for 12.1 million patients with HF and 3.0 million patients with incident HF ≥25 years old. Both prevalence and incidence increased with increasing age (0.57%, 3.86%, and 7.55% for prevalence and 158, 892, and 1655 per 100 000 person-years for incidence among persons who were 25–64, 65–79, and ≥80 years of age, respectively). The inpatient mean cost per-capita was $4406.8 and the proportion with ≥3 hospitalizations among those hospitalized was 40.5%. The outpatient mean cost per-capita was $892.3. Conclusions: HF has placed a considerable burden on health systems in China, and strategies aimed at the prevention and treatment of HF are needed. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: ChiCTR2000029094.

Aims Frailty in older patients with stage B heart failure with preserved ejection fraction (HFpEF) has not been fully explored. We evaluated the prevalence and prognostic significance of frailty in older patients diagnosed with stage B HFpEF. Methods Our prospective cohort study included inpatients aged ≥65 years who were followed up for 3 years. Stage B HFpEF was defined as cardiac structural or functional abnormalities with a left ventricular ejection fraction (LVEF) ≥ 50% without signs or symptoms. Frailty was assessed using the Fried phenotype. The primary outcome was 3‐year all‐cause mortality or readmission. Results Overall, 520 older inpatients diagnosed with stage B HFpEF [mean ± standard deviation age: 75.5 ± 6.25 years, male: 222 (42.7%)] were included in the study. Of these, 145 (27.9%) were frail. Frail patients were older (78.5 ± 6.23 vs. 74.3 ± 6.22 years, P < 0.001), with a lower body mass index (24.6 ± 3.60 vs. 25.7 ± 3.27 kg/m 2 , P = 0.001), higher level of N‐terminal pro‐B‐type natriuretic peptide [279 (interquartile range: 112.4, 596) vs. 140 (67.1, 266) pg/mL, P < 0.001], longer timed up‐and‐go test result (19.9 ± 9.71 vs. 13.3 ± 5.08 s, P < 0.001), and poorer performance in the short physical performance battery (4.1 ± 3.26 vs. 8.2 ± 2.62, P < 0.001), basic activities of daily living (BADL, 4.7 ± 1.71 vs. 5.7 ± 0.57, P < 0.001), and instrumental activities of daily living (IADL, 4.4 ± 2.73 vs. 7.4 ± 1.33, P < 0.001). Frail patients were more likely to have a Mini‐Mental State Examination (MMSE) score <24 (55.9% vs. 28.8%, P < 0.001) and take more than five medications (64.1% vs. 47.2%, P = 0.001). Frail patients had a higher incidence of all‐cause mortality or readmission (62.8% vs. 47.7%, P = 0.002), all‐cause readmission (56.6% vs. 45.9%, P = 0.029), and readmission for non‐heart failure (55.2% vs. 41.3%, P = 0.004) during the 3‐year follow‐up, with a 1.53‐fold (95%CI 1.11–2.11, P = 0.009) higher risk of all‐cause mortality or readmission, a 1.52‐fold (95%CI 1.09–2.11, P = 0.014) higher risk of all‐cause readmission, and a 1.70‐fold (95%CI 1.21–2.38, P = 0.002) higher risk of readmission for non‐clinical heart failure, adjusted for sex, age, polypharmacy, Athens Insomnia Scale, MMSE, LVEF, BADL, and IADL. Conclusions Frailty is common in elderly patients with stage B HFpEF. Physical frailty, particularly low physical activity, can independently predict the long‐term prognosis in these patients.

Background: Characteristics of heart failure with recovered ejection fraction (HFrecEF) have not yet been fully understood. The objective of this study is to identify potential biomarkers for the left ventricular ejection fraction(LVEF) recovery. Methods: Antibody microarrays were used to detect proteins in serum of healthy volunteers, patients with heart failure with reduced ejection fraction(HFrEF), and patients with HFrecEF, looking for specific proteins of HFrecEF patients.Results:1000 proteins were detected in the sera of healthy volunteers, HFrEF patients and HFrecEF patients using antibody microarrays (three in each group). There were dozens of different proteins between each group. Based on the signal strength, fold changes, clinical significance and Venn diagram analysis, 11 proteins were selected to be detected in the sera of 10 healthy volunteers ,47 HFrEF patients and 22 HFrecEF patients using antibody microarrays. Serum concentrations of cysteine dioxygenase type 1 (CDO1) and growth/differentiation factor 8 (GDF-8) were significantly downregulated in HFrecEF patients compared with HFrEF patients. ROC curve analysis showed that the area under the CDO1 curve was 0.662(95%CI 0.517-0.808,P=0.031).The sensitivity of CDO1 was 77%, the specificity was 54%, and diagnostic cut‑off points was 10198.5.The GDF-8 has no diagnostic value. Kaplan–Meier survival curves showed that the prognosis is better in HFrecEF patients than HFrEF patients about all cause death(P=0.011) and cardiovascular death(P=0.004).But we did not find that patients with low baseline CDO1 levels (<10198.5) had better outcomes than those with high CDO1 levels (≥10198.5).Conclusions: This pilot study indicates that CDO1 is a potential biomarker of LVEF recovery, which needs to be confirmed by further studies.

Purpose Elderly heart failure (HF) patients have different clinical characteristics and poorer prognosis compared with younger patients. Prognostic risk scores for HF have not been validated well in elderly patients. We aimed to validate the Seattle Heart Failure Model (SHFM) and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score in an elderly Chinese HF cohort. Patients and Methods This retrospective study enrolled 675 elderly HF patients (age≥70 years) discharged from our hospital between 2012 and 2017. The performance of the two risk scores was evaluated in terms of discrimination, using receiver-operating characteristic analysis, and calibration using a calibration plot and Hosmer–Lemeshow (H-L) test. Absolute risk reclassification was used to compare the two scores. Results During the mean follow-up time of 32.6 months, 193 patients (28.6%) died, and 1-year mortality was 10.5%. The predicted median 1-year mortality was 8% for the SHFM and 18% for the MAGGIC score. A Kaplan–Meier survival curve demonstrated that event rates of all-cause mortality significantly increased with increasing SHFM and MAGGIC scores. The discriminatory capacity of the SHFM was greater than that of the MAGGIC score (c-statistics were 0.72 and 0.67, respectively; P = 0.05). The calibration plot for the SHFM was better than that for MAGGIC score for 1-year mortality (SHFM: H-L χ 2 =8.2, P = 0.41; MAGGIC: H-L χ 2 =18.8, P =0.02). Compared with the MAGGIC score, the net reclassification index (NRI) of the SHFM was 2.96% (Z=5.88, P< 0.0001). Conclusion The SHFM performs better than MAGGIC score, having good discrimination, calibration and risk classification for the prediction of 1-year mortality in elderly Chinese HF patients.