Analysis of clinical characteristics, diagnosis and treatment status of hospitalized patients with chronic heart failure in Xinjiang,China

doi:10.21203/rs.3.rs-1961093/v1

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Research Article

Analysis of clinical characteristics, diagnosis and treatment status of hospitalized patients with chronic heart failure in Xinjiang,China

https://doi.org/10.21203/rs.3.rs-1961093/v1

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Purpose

To investigate and analyze the demographic data, clinical characteristics, treatment and prognosis of hospitalized patients with chronic heart failure (CHF) in Xinjiang.

Methods

The data included in this study are the subgroup data from the Xinjiang of the China Heart Failure Center Registration Study. From January 1, 2018 to September 1, 2020, 7677 CHF patients who meet the CHF diagnostic criteria and have complete clinical data will be treated as the research objects. Collect selected demographic data, heart failure risk factors, heart failure etiology, laboratory and examination results, medication use and prognosis information.

Results

(1)The causes of CHF are: coronary atherosclerotic heart disease (65.57%), dilated cardiomyopathy (11.05%), hypertension (9.01%) and valvular heart disease (8.7%).༈2༉A total of 78 CHF patients (1.00%) died in the hospital during hospitalization. A total of 512 CHF deaths (6.8%) occurred within 12 months of discharge.༈3༉HFpEF patients are older, the proportion of women is the highest, and the proportion of patients with CHF comorbidities is the highest (P < 0.05).༈4༉Although there was no significant difference in the standardized medications of CHF in the provincial and municipal tertiary hospitals, the proportion of pacing intervention and coronary revascularization in the provincial tertiary hospitals was higher than that in the municipal tertiary hospitals (P < 0.05).

Conclusion

The main cause of CHF in Xinjiang is coronary heart disease, and patients with different types of CHF have different clinical characteristics. The mortality rate of CHF inside and outside the hospital is still high, and there is a certain gap between the treatment practice of CHF in Xinjiang and the treatment recommended by the guidelines. It is necessary to establish and improve a standardized, individualized, and standardized diagnosis and treatment system for CHF in Xinjiang.

Chronic heart failure

diagnosis

treatment

Heart failure (HF) is a complex clinical syndrome caused by structural or functional heart disease. According to the "World Health Statistics Report" released by the World Health Organization, there are 64.3 million people suffer from chronic heart failure (CHF)in the world ^[1]. According to the "China Cardiovascular Health and Disease Report 2020", the number of CHF patients in China has reached 8.9 million ^[2]. Xinjiang Uygur Autonomous Region, or "Xinjiang" for short, is located in Northwest China. It covers an area of 1.66 million square kilometers, accounting for one-sixth of China's total land area. According to the seventh Chinese census in 2020, the permanent population of Xinjiang is 25,852,300. Based on this estimate, the number of HF patients in Xinjiang may have exceeded 2.21 million. Due to the rapid aging of China's current population and the prevalence of cardiovascular risk factors such as hypertension, diabetes, and obesity, the total number of HF patients is still increasing rapidly and has become an increasingly serious public health burden^[3].

The incidence of HF varies with living environment, genetic background and socioeconomic factors^[3-5]. Due to the high-salt and high-fat eating habits of people in Xinjiang, the prevalence of cardiovascular complications such as coronary heart disease and hypertension is relatively high. The economy is underdeveloped and residents in remote areas have insufficient knowledge of the disease, many patients go to the hospital after their cardiac function has been significantly reduced, which has led to the consumption of a large amount of medical resources.

This study investigated the demographic data, clinical characteristics, diagnosis and treatment methods, and prognosis of hospitalized heart failure patients in Xinjiang, aiming to reflect the current status of diagnosis and treatment of hospitalized CHF patients, and to explore the potential gap between clinical practice and guideline-recommended standardized treatment. Create an evidence-based, effective and cost-effective CHF diagnosis and treatment system to provide evidence-based medicine evidence and standardize the CHF diagnosis and treatment procedures in Xinjiang.

1.Research object:

The data included in this study is the Xinjiang subgroup data of the Chinese Heart Failure Center Registration Study (ChiCTR1800017226). There are 21 hospitals in Xinjiang that have reported and reviewed the data of CHF patients, including 3 provincial-level Class-A hospitals and 18 municipal-level Class-A hospitals. A total of 7677 patients with CHF who met the diagnostic criteria of CHF [6] and had complete clinical data and were continuously hospitalized from January 1, 2018 to September 1, 2020 were selected as the research objects. The registration study of the China Heart Failure Center has been approved by the Beijing Hospital Ethics Committee (2018BJYYEC 059 02).

2.Clinical data collection:

All patients were met the diagnostic criteria of CHF, the patient data is filled in the platform of the official website of China Heart Failure Center (website: www.chinahfc.org) by the physician in charge establish a clinical database to collect patient information including: general data (age, gender, ethnicity), lifestyle (smoking, drinking), clinical data (days of hospitalization, cause of heart failure, the history of hypertension, coronary heart disease, diabetes, myocardial infarction, atrial fibrillation, and chronic kidney disease, medical history, heart function classification), laboratory results (NT-Pro BNP, BNP, blood routine, renal function, electrolytes), examination results (Cardiac ultrasound results, chest X-ray), heart failure medication and other information.

3. Follow-up

All patients were followed-up by telephone or outpatient with one week, one month, three months and one year after discharge, filled the data in the platform of the Heart Failure Center official website.

4. Quality control:

All patient data were filled in by professionally trained cardiovascular medical staff, and successfully passed the superior review and archiving procedures. All data have successfully passed the All data have successfully passed the expert review of the data management expert group of the Chinese Heart Failure Center. When the research group compiled the clinical database, all the data were analyzed and eliminated again.

5. Statistical analysis:

The statistical software IBM SPSS Statistics 23.0 software package was used for statistical analysis, the measurement data conforming to the normal distribution were expressed by the mean ± standard, and the component comparison was made by t test. Non-normal data are represented by median (P25% and P75%), and a two-sample nonparametric test (Mann-Whitney U test) is used. The chi-square test was used to compare the count data between groups. Two-sided test P<0.05 indicates that the difference is statistically significant.

1. Epidemiological characteristics of hospitalized CHD patients in Xinjiang

Demographic data: A total of 7677 patients with chronic heart failure were included in this study, including 4777 males (62.2%) and 2900 females (37.8%). The average age was 68.11±13.65 years old, of which 1455 cases (18.9%) were 50-59 years old, 1709 cases (22.2%) were 60-69 years old, 2019 cases were 70-79 years old (26.3%), and 1720 cases were over 80 years old (22.4%) ). There were 2269 cases (29.6%) with a history of smoking. A total of 1493 cases (19.5%) had a history of drinking. (Table 1, Figure 1)

2. Clinical data: 6532 cases (85.1%) have perfected BNP or NT-Pro BNP. The cardiac function classification is as follows: 2555 cases (33.28%) of cardiac function II, 3489 cases (45.45%) of III, 1633 cases (21.27%) of IV. A total of 2946 cases (43.10%) of heart failure with reduced ejection fraction（HFrEF) patients with an ejection fraction ≤40 were found. HFrEF was 41-49range ejection fraction (HFmrEF) patients totaled 1480 (21.66%), and 2408 patients (35.24%) had heart failure with preserved ejection fraction（HFpEF) with an ejection fraction ≥50%. The causes of CHF are: coronary atherosclerotic heart disease in 5034 cases (65.57%), dilated cardiomyopathy in 848 cases (11.05%), hypertension in 692 cases (9.01%) and valvular heart disease in 673 cases (8.7%) . 687 patients (8.9%) had coronary revascularization (coronary artery intervention and bypass). There were 1886 cases (24.5%) of atrial fibrillation/atrial flutter. CRT-D/CRT-P implanted in 120 cases (1.5%), ICD implanted in 93 cases (1.2%), and single-chamber/dual-chamber pacemaker implanted in 358 cases (4.6%). The proportion of comorbidities in patients with chronic heart failure was in descending order: 1735 cases of anemia (22.6%), 938 cases of hyponatremia (12.8%), 969 cases of chronic obstructive pulmonary disease (12.62%), and 756 cases of chronic kidney disease. (9.9%), 754 cases of stroke/transient ischemic attack (9.8%), 618 cases of hypokalemia (8.46%), 600 cases of abnormal thyroid function (7.82%), and 126 cases of malignant tumor (1.64%) . The median hospital stay was 8 days. (Table 1, Figure 2)

3. The prognosis of chronic heart failure:A total of 78 CHF patients (1.00%) died in the hospital during hospitalization. CHF patients will be followed up regularly for 1 week, January, March, and December after being discharged from the hospital. Follow-up methods include telephone and outpatient follow-up. All patients need to be followed up for 20,371 person-times and 16,049 follow-ups are completed. Need to complete the 1-week follow-up of 6708 people after discharge, and successfully complete the 1-week follow-up of 5498 people. The completion rate of follow-up was 81.96%. Among them, the number of deaths after one week of discharge: 71 people. It is necessary to complete 6138 follow-up visits in 1 month after discharge, and 5019 follow-up visits in 1 month after discharge. The completion rate of follow-up is 81.77%. Among them, the number of deaths after 1 month of discharge: 125. It is necessary to complete 5436 follow-up visits for 3 months after discharge, and 4352 follow-up visits for 3 months after discharge. The follow-up completion rate is 80.06%. Among them, the number of deaths after 3 months of discharge: 146. Need to complete the 12-month follow-up follow-up of 2060 people, and successfully complete the 12-month follow-up follow-up of 1155 people. The follow-up completion rate is 56.07%. Among them, the number of deaths after 12 months of discharge: 101 people. A total of 512 CHF deaths (6.8%) occurred within 12 months of discharge.

2. Epidemiological characteristics of CHF patients with different ejection fractions

(1) Demographic data: Comparing the three groups of patients with HFpEF, HFmrEF and HFrEF, smoking (P<0.001) and drinking (P<0.001) accounted for the highest proportion of HFrEF patients. HFpEF patients are older (P<0.001), and the proportion of women is the highest (P<0.001). (Table 2)

(2) Clinical data:Compared with HFmrEF and HFpEF groups, patients with HFrEF had a faster resting heart rate (P<0.001), the lowest ejection fraction (P<0.001), and the highest levels of BNP (P<0.001) and NT-Pro BNP (P<0.001). CRT-D/CRT-P (P<0.001) and ICD implantation accounted for the highest proportion (P<0.001). Compared with the HFmrEF and HFrEF groups, patients with HFpEF had higher systolic blood pressure (P＜0.001), lower diastolic blood pressure (P＜0.001), and the highest proportion of patients with heart function grade IV (P＜0.001). The highest proportion of patients with coronary revascularization (P=0.020); combined with diabetes (P<0.001), stroke/transient ischemic attack (P=0.015), anemia (P<0.001), chronic obstructive pulmonary disease (P＜0.001) and other cardiovascular complications accounted for the highest proportion. There was no significant difference in body mass index between the three groups (P>0.05). The causes of HFrEF patients are: coronary atherosclerotic heart disease, dilated cardiomyopathy, hypertension and valvular heart disease. The causes of patients with HFmrEF are: coronary atherosclerotic heart disease, hypertension, dilated cardiomyopathy and valvular heart disease. The causes of CHF in patients with HFpEF are: coronary atherosclerotic heart disease, valvular heart disease, hypertension and dilated cardiomyopathy. (Table 2)

The difference in treatment of HFrEF patients hospitalized in provincial-level tertiary hospitals and municipal tertiary hospitals

As shown in Table 3, the use rates of renin-angiotensin system inhibitors, β-receptor blockers and aldosterone receptor antagonists in hospitalized HFrEF patients in Xinjiang were 91.19%, 91.15% and 90.96%, respectively. The use rates of renin-angiotensin system inhibitors were 91.6% and 90.8% in patients with HFrEF hospitalized in provincial and municipal top-level hospitals, and the use rates of β-blockers were 91.6% and 90.8%, respectively. The medication rates of aldosterone receptor antagonists were 89.5% and 91.9%, respectively. Compared with the three provincial hospitals, the use rate of diuretics (P<0.001) and digoxin (P<0.001) in municipal top-level hospitals is high, and the use rate of traditional Chinese medicine is low (P=0.002). (table 3)

Due to the aging of the population, the rapid population growth and the improvement of cardiovascular disease diagnosis and treatment technology, the social burden of HF will continue to rise.At the same time, the diagnosis and treatment of HF will also face increasingly severe challenges.Since the epidemiological characteristics, etiology, management and outcome of CHF vary from country to country, region, and ethnicity ^[5], it is necessary to develop a targeted, regionally-specific CHF standardized management system that is important to reduce the occurrence, development and prognosis of CHF Meaning.In order to create an evidence-based, life-saving and cost-saving inpatient CHF diagnosis and treatment system in Xinjiang to provide evidence-based medical evidence, we researched and investigated the demographic data, clinical characteristics and management of inpatient CHF patients in Xinjiang.

Our research found that there are more men (62.2%) of CHF patients hospitalized in Xinjiang, which is similar to the proportion of men in the registration study of China-HF^[7].Therefore, early intervention of risk factors such as smoking, drinking, and complications such as coronary heart disease, hypertension, and obesity in the male population may be of great significance to the prevention and treatment of CHF ^[8].The median hospital stay of CHF patients in this study is 8 days, which is shorter than that of studies such as China-HF [7] and China PEACE ^[9], which may be related to the improvement of the efficiency of heart failure treatment under the new treatment model of CHF.

Coronary atherosclerotic heart disease (65.57%) is the leading cause of CHF hospitalization in Xinjiang.This may be related to the heavy burden of coronary heart disease risk factors such as smoking, high-fat diet, obesity, diabetes, and hypertension, which are consistent with the results of studies in Western countries ^[10-12].However, according to China-HF^[7] research report, hypertension is the main reason for CHF in hospitals in my country.The reason for this difference may be that Xinjiang is a region where many ethnic groups gather.People of all ethnic groups in Xinjiang mainly eat dairy products such as beef, mutton, milk tea, and pasta. The source of animal protein in the diet is single, and the saturated fatty acid and cholesterol content of animal fat is relatively high, and the long-term high salt content is high. Fatty eating habits and lack of understanding of the disease have caused the ethnic minorities in Xinjiang to not pay enough attention to the control of risk factors for coronary heart disease such as hyperlipidemia, hyperglycemia, and hypertension.It is worth noting that the second leading cause of heart failure patients in Xinjiang is dilated cardiomyopathy (11.05%), followed by hypertension (9.01%), which is consistent with Arab countries in the Middle East ^[13], and is different from Western countries, even with The survey of HF patients in Xinjiang published by Jiang Hua et al. ^[14] in 2015 is different.The reason may be related to the increasing economic development in Xinjiang, the improvement of people's health awareness, the comprehensive popularization of national medical examinations, and the implementation of early detection, early diagnosis, and early intervention of the diagnosis and treatment system for hypertension.We included mainly CHF patients with HFrEF (43.10%) and 729 patients (45.45%) with heart function grade III.This may be related to factors such as the fact that CHF patients in Xinjiang did not see a doctor until their cardiac function was significantly reduced, the proportion of hospitalized HFrEF patients in provincial-level tertiary hospitals was relatively high, and the strict implementation of the CHF graded diagnosis and treatment system.

The ratio of HFrEF and HFpEF in our study is close, which is consistent with the results of China-HF ^[7].In our study, we found that the proportion of smoking and drinking in HFrEF patients is the highest.The causes of FFrEF patients are: coronary atherosclerotic heart disease, dilated cardiomyopathy, hypertension and valvular heart disease.The long-term registration of heart failure by the European Society of Cardiology is a prospective observational study result suggesting ^[15] that patients with HFrEF are younger, more commonly male, and more likely to have ischemic causes, consistent with our findings.HFpEF refers to a type of HF with normal or near normal cardiac ejection fraction, but with clinical manifestations of HF symptoms or signs.The term HFpEF has undergone several evolutions, from initially diastolic dysfunction HF to normal systolic functional HF, and finally defined by the European Society of Cardiology in 2016 as the current ejection fraction reserved HF.Age is an independent risk factor for HFpEF, and the incidence of HFpEF increases with age higher than HFrEF^[16].The average age of HFpEF patients is 70 years old, and men and obese patients may be diagnosed with HFpEF earlier ^[17,18].Relevant studies have shown that female patients are more likely to have HFpEF, which may be related to the increased life expectancy of women than men, and the increased burden of HF risk factors such as hypertension and diabetes in elderly women ^[19,20].Our research results suggest that the average age of HFpEF patients is older, the proportion of women is high, the systolic blood pressure is high, the diastolic blood pressure is low, the proportion of coronary artery revascularization is high, and the patients with diabetes, anemia, stroke/transient ischemic attack and chronic obstruction The proportion of comorbidities such as sexual lung disease is the highest. Consistent with the above research results.

The treatment of CHF has undergone a major shift since the 1990s: it has shifted from the aim of improving short-term hemodynamics to a long-term repair strategy to change the biological properties of the failing heart.Since 2017, the drug treatment of CHF has developed spontaneously, ranging from angiotensin receptor enkephalinase inhibitors ^[21] to sodium glucose transporter 2 ^[22], and then to veliciae^[23]. It is not a new "star" drug in the field of CHF treatment.Our research found that the HF standardized drugs for HFrEF patients in Xinjiang: renin-angiotensin system inhibitors, β-receptor blockers and aldosterone receptor antagonists were 91.19%, 91.15 and 90.96%, respectively.Compared with the proportion of standardized drugs used in Xinjiang HF patients reported by Jiang Hua et al. [14] five years ago, it has been significantly increased.It is suggested that the drug treatment of HFrEF patients in Xinjiang is gradually moving towards a more standardized, standardized and optimized development path.Surprisingly, the proportion of drugs used in the “Golden Triangle” of HFrEF patients in Xinjiang is higher than that of China-HF^[7], China PEACE^[9], and Asian CHAMP-HF^[24]. This is inseparable from the cardiovascular system of all ethnic groups in Xinjiang. Physicians continue to study and study the CHF guidelines.The use rates of renin-angiotensin system inhibitors were 91.6% and 90.8% in patients with HFrEF hospitalized in provincial and municipal top-level hospitals, and the use rates of β-blockers were 91.6% and 90.8%, respectively.The medication rates of aldosterone receptor antagonists were 89.5% and 91.9%, although there was no statistically significant difference, but the proportion of pacing intervention (CRT-D/CRT-P/ICD) and coronary intervention or bypass treatment in the three provincial hospitals Higher than municipal tertiary hospitals,This reminds that the basic understanding of the guidelines for the treatment of CHF in the provincial tertiary hospitals and municipal tertiary hospitals in Xinjiang is basically the same, but the municipal tertiary hospitals are limited by the conditions of the hospital and the level of doctors, and the latest treatment plan for CHF and the latest equipment treatment technology Awareness and practical ability needs to be improved.At the same time, studies have found that doctors in various regions of China have obviously insufficient mastery of the basic knowledge of HF. The degree of mastery of the CHF guidelines may be related to the doctor's qualifications, hospital level, practice scope and other factors^[25], and the provincial tertiary hospitals have a high degree of education. , Senior seniority, and a team of cardiovascular specialists, so CHF’s latest drugs and latest device treatment technologies may be easier to popularize.

In our study, the in-hospital mortality rate of CHF patients is 1.00%, which is low in China-HF^[7]. It may be related to factors such as end-stage CHF patients not being able to come to the hospital for treatment, giving up treatment at the end of life, and requiring automatic discharge from the hospital.In our study, the regular follow-up rates of CHF patients 1 week, January, March and December were 81.96%, 81.77%, 80.06% and 56.07%, respectively.The 12-month follow-up rate after discharge has dropped significantly, and the out-of-hospital follow-up management system for CHF patients needs to be improved.A total of 512 CHF patients died within 12 months of discharge (6.8%). The low out-of-hospital mortality rate may be related to factors such as more dead patients among the lost to follow-up and low follow-up rate. The standardized follow-up system needs to be improved to accurately evaluate Xinjiang Standardized mortality of CHF patients in the region.

This study has certain limitations. Although the headquarters of the Heart Failure Center has requested the hospital to continuously enroll CHF patients, the reporting doctor may choose some patients with more standardized medications for reporting, so a certain selection bias has occurred.In addition, this study only analyzed the standardized drug use rate of CHF patients, but did not analyze whether the drug has reached the target dose.The success rate of follow-up in this study was low, especially the 1-year follow-up rate was only 56.07%. Therefore, the reliability of prognostic data is low.

In summary, the main cause of chronic CHF in Xinjiang is coronary heart disease, which is different from previous domestic and foreign studies.Early intervention on the risk factors of coronary heart disease may have a certain significance for the occurrence and development of CHF in Xinjiang.There is a certain gap between CHF treatment practice in Xinjiang and the treatment recommended by the guidelines, including the availability of diagnostic tests, and the incomplete popularization of the latest treatment drugs and device technologies.Provincial-level tertiary hospitals should give full play to their advantages and take up the task of training, guiding and radiating the surrounding grassroots hospitals at all levels.Primary hospitals should actively implement the CHF graded diagnosis and treatment and two-way referral model, implement standardized diagnosis and treatment and long-term patient follow-up management based on HF guidelines, improve the overall diagnosis and treatment of heart failure, and establish and improve the standardized, individualized, and standardized diagnosis and treatment of CHF in Xinjiang. system.

The manuscript has been read and approved by all the authors, the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work.

Ethical approval and consent to participate:

The registration study of the China Heart Failure Center has been approved by the Beijing Hospital Ethics Committee (2018BJYYEC 059 02).Informed consent to participate in the study was obtained from participants. All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication:

Not applicable.

Availability of data and materials：

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interest:

The author reports no conflicts of interest in this work.

Funding：

This work was financially supported by the Key Project of Natural Science Foundation of Xinjiang Autonomous Region (No. 81660695).

Authors’ Contributions：

Refukaiti·Abuduhalike and Aihaidan·Abudouwayiti performed experimental analysis and drafted this manuscript. Kailibinuer·Abuduhalike and Kamaliding·Nazimu conducted extensive literature searches.Sun Juan did statistical analysis.Ailiman·MaheMuti designed the study and made critical revisions to the manuscript and contributed to the rationalization of the study. All authors read and ap-proved the final manuscript.

Acknowledgment:

We sincerely thank the China Heart Failure Center Headquarters (Yang Jiefu), Xinjiang Uygur Autonomous Region People's Hospital (Peng Hui), Xinjiang Medical University Affiliated Traditional Chinese Medicine Hospital (Li Peng), the Fifth Affiliated Hospital of Xinjiang Medical University (Cao Guiqiu), and the First People's Hospital of Kashgar (Maimati Aili), Xinchang Jizhou Traditional Chinese Medicine Hospital (Guiliang), Karamay Central Hospital (Liu Xiaohong), Yili Kazakh Autonomous Prefecture Friendship Hospital (Ziyawudong·Bawudong), Xinjiang Production and Construction Corps First Division Hospital ( Luo Ren), the Second People's Hospital of Kashgar District, Xinjiang (Rao Fang), Shanshan County People's Hospital (Yue Yongyue), Xinjiang Maegiti County People's Hospital (Xuqin), Aksu District First People's Hospital (Ma Jianjun), Borta La Mongol Autonomous Prefecture People’s Hospital (Bayinbat), Xinjiang Uygur Autonomous Region Third People’s Hospital (Lv Hong), Hami Central Hospital (Lin Tao), Shaya County People’s Hospital (Ji zonggao), Huocheng County First People’s Hospital (Liu Binghui ), Shihezi City People’s Hospital (Han Yihui), Turpan City Second People’s Hospital (Zhu Ziyuan), Xinjiang Production and Construction Corps Sixth Division Qitai Hospital (Cui Xuelin).

Author details：

Refukaiti·Abuduhalike,Aihaidan·Abudouwayiti,Kailibinuer·Abuduhalike,Kamaliding·Nazimu

,Sun Juan, Ailiman·Mahemuti

Refukaiti·Abuduhalike:Cardiovascular department of The First Affiliated Hospital of Xinjiang Medical University，137 Carp Road,. Xinshi District, Urumqi 830054, Xinjiang, China.

Aihaidan·Abudouwayiti:The First Affiliated Hospital of Xinjiang Medical University，137 Carp Road,. Xinshi District, Urumqi 830054, Xinjiang, China.

Kailibinuer·Abuduhalike:The First Affiliated Hospital of Xinjiang Medical University，137 Carp Road,. Xinshi District, Urumqi 830054, Xinjiang, China.

Kamaliding·Nazimu:The First Affiliated Hospital of Xinjiang Medical University，137 Carp Road,. Xinshi District, Urumqi 830054, Xinjiang, China.

Sun Juan:Cardiovascular department of The First Affiliated Hospital of Xinjiang Medical University，137 Carp Road,. Xinshi District, Urumqi 830054, Xinjiang, China.

Ailiman·Mahemuti:Cardiovascular department of The First Affiliated Hospital of Xinjiang Medical University，137 Carp Road,. Xinshi District, Urumqi 830054, Xinjiang, China.

Collaborators G, D a I. I a P.Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017[J].Lancet,2018, 392 (10159): 1789–1858.
The Writing Committee of the Report on Cardiovascular Health. and Diseases in China, Interpretation of Report on Cardiovascular Health and Diseases in China 2020. [J] Chin J Cardiovasc Med. 2021;26(03):209–18.
Groenewegen A, Rutten FH, Mosterd A, et al. Epidemiology of heart failure[J]. Eur J Heart Fail. 2020;22(8):1342–56.
Roger VL.Epidemiology of Heart Failure. A Contemporary Perspective[J].Circ Res,2021, 128 (10): 1421–1434.
Tromp J, Ferreira JP, Janwanishstaporn S, et al. Heart failure around the world[J]. Eur J Heart Fail. 2019;21(10):1187–96.
Heart Failure Group of Chinese Society of Cardiology of Chinese Medical Association, Chinese Heart Failure Association of Chinese Medical Doctor Association., Editorial Board of Chinese Journal of Cardiology, Chinese guidelines for the diagnosis and treatment of heart failure 2018[J].Chinese Journal of Cardiology,2018, 46 (10): 760–789.
Zhang Y, Zhang J, Butler J, et al.Contemporary Epidemiology, Management, and Outcomes of Patients Hospitalized for Heart Failure in China: Results From the China Heart Failure (China-HF) Registry[J].J Card Fail,2017, 23 (12): 868–875.
Lam CSP, Arnott C, Beale AL, et al. Sex differences in heart failure[J]. Eur Heart J. 2019;40(47):3859–68c.
Yu Y, Gupta A, Wu C, et al. Characteristics, Management, and Outcomes of Patients Hospitalized for Heart Failure in China: The China PEACE Retrospective Heart Failure Study[J]. J Am Heart Assoc. 2019;8(17):e012884.
Alfaleh H, Elasfar AA, Ullah A, et al. Worsening heart failure in 'real-world' clinical practice: predictors and prognostic impact[J]. Eur J Heart Fail. 2017;19(8):987–95.
Balsam P, Ozierański K, Kapłon-Cieślicka A, et al. Differences in clinical characteristics and 1-year outcomes of hospitalized patients with heart failure in ESC-HF Pilot and ESC-HF-LT registries[J]. Pol Arch Intern Med. 2019;129(2):106–16.
Lund LH, Claggett B, Liu J, et al. Heart failure with mid-range ejection fraction in CHARM: characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum[J]. Eur J Heart Fail. 2018;20(8):1230–9.
Elasfar AA, Alhabeeb W, Elasfar S.Heart Failure in the Middle East Arab Countries: Current and Future Perspectives[J].J Saudi Heart Assoc,2020, 32 (2): 236–241.
Jiang, Hua, Zhang Hong wei, Zhou Xian hui, et al.Clinical Characteristics and Current Treatment Status in Patients With Chronic Heart Failure at Different Grade Hospitals in Xinjiang Area[J].Chinese Circulation Journal,2015, 30 (12): 1186–1190.
Chioncel O, Lainscak M, Seferovic PM, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry[J]. Eur J Heart Fail. 2017;19(12):1574–85.
Dunlay SM, Roger VL, Redfield MM. .Epidemiology of heart failure with preserved ejection fraction[J]. Nat Rev Cardiol. 2017;14(10):591–602.
Mohammed SF, Borlaug BA, Roger VL, et al. Comorbidity and ventricular and vascular structure and function in heart failure with preserved ejection fraction: a community-based study[J]. Circ Heart Fail. 2012;5(6):710–9.
Obokata M, Reddy YNV, Pislaru SV, et al.Evidence Supporting the Existence of a Distinct Obese Phenotype of Heart Failure With Preserved Ejection Fraction[J].Circulation,2017, 136 (1): 6–19.
Gladden JD, Chaanine AH, Redfield MM. .Heart Failure with Preserved Ejection Fraction[J]. Annu Rev Med. 2018;69:65–79.
Pandey A, Omar W, Ayers C, et al.Sex and Race Differences in Lifetime Risk of Heart Failure With Preserved Ejection Fraction and Heart Failure With Reduced Ejection Fraction[J].Circulation,2018, 137 (17): 1814–1823.
Mcmurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure[J]. N Engl J Med. 2014;371(11):993–1004.
Wiviott SD, Raz I, Bonaca MP, et al.Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes[J],2019, 380 (4): 347–357.
Armstrong PW, Roessig L, Patel MJ, et alMulticenter A. Randomized, Double-Blind, Placebo-Controlled Trial of the Efficacy and Safety of the Oral Soluble Guanylate Cyclase Stimulator: The VICTORIA Trial[J].JACC Heart Fail,2018, 6 (2): 96–104.
Teng TK, Tromp J, Tay WT, et al. Prescribing patterns of evidence-based heart failure pharmacotherapy and outcomes in the ASIAN-HF registry: a cohort study[J]. Lancet Glob Health. 2018;6(9):e1008–18.
Gan T, Zhang Y, Liu N, et al.Gap Between Clinical Practice and Guidelines: A National Survey of the Knowledge of Recommended Heart Failure Guidelines Among Chinese Physicians[J].Qual Manag Health Care,2017, 26 (4): 196–204.

Table1 Clinical characteristics of CHF inpatients in Xinjiang

			n	mean			n	mean
Age (years)			7677	68.11±13.65	Types of HF	HFpEF	7677	2408(35.24)
						HFmrEF		1480(21.66)
						HFrEF		2946(43.10)
sex	Female[n(%)]		7677	2900(37.8)	Coronary revascularization [n(%)]		7677	687(8.9)
	Male[n(%)]			4777(62.2)	Atrial fibrillation/flutter[n(%)]		7677	1886(24.5)
smoke	never[n(%)]		7677	5408(70.4)	CRT-D/CRT-P[n(%)]		7677	120(1.5)
	before[n(%)]			1296(16.8)	ICD[n(%)]		7677	93(1.2)
	now[n(%)]			973(12.6)	Single-chamber/dual-chamber pacemaker		7677	358(4.6)
drink	never[n(%)]		7677	6184(80.5)	Diabetes[n(%)]		7677	2324(30.2)
	before[n(%)]			756(9.85)	Stroke/TIA[n(%)]		7677	754(9.8)
	now[n(%)]			737(9.6)	Hb(g/L)		6922	132.19±23.00
BMI(kg/m²)			5276	25.74±4.57	Anemia[n(%)]		6922	1735(22.6)
Systolic blood pressure (mmHg)			7677	117.10±21.87	Blood creatinine(μmol/L)		7105	82(66.76,104.0)
Diastolic blood pressure (mmHg)			7677	76.26±14.07	CKD[n(%)]		7677	765(9.9)
Heart rate (beats per minute)			7677	83.80±17.17	Blood sodium(mmol/L)		7302	139.03±5.32
EF(%)			6834	44.78±12.86	Hyponatremia[n(%)]		7302	938(12.8)
BNP(pg/mL)			3357	900.00(287.50，2025.20)	Serum potassium(mmol/L)		7302	4.11±0.49
NT-Pro BNP(pg/mL)			3175	2400.00(890.00，5663.00)	Hypokalemia[n(%)]		7302	618(8.46)
NYHA Heart Function Classification[n(%)]		II级	7677	2555(33.28)	COPD[n(%)]		7677	969(12.62)
		III级		3489(45.45)	Abnormal thyroid function[n(%)]		7677	600(7.82)
		IV级		1633(21.27)	Malignant tumor[n(%)]		7677	126(1.64)
					Hospitalization days		7767	8.00(6.0,10.0)

Table 2 Clinical characteristics of CHF patients with different types in Xinjiang

	HFrEF (n=2946)	HFmrEF (n=1480)	HFpEF (n=2408)	P
Age (years)	64.75±13.67	67.91±13.06	71.90±12.94	＜0.001
Female[n(%)]	856(29.1)	511(34.5)	1180(49.0)	＜0.001
Male[n(%)]	2090(70.9)	969(65.5)	1300(51.0)
smoke				＜0.001
never[n(%)]	1935(65.7)	1010(68.2)	1822(75.7)	-
before[n(%)]	586(19.9)	259(17.5)	342(14.2)	-
now[n(%)]	425(14.4)	211(14.3)	244(10.1)	-
drink				＜0.001
never[n(%)]	2282(77.5)	1156(78.1)	2029(84.3)	-
before[n(%)]	346(11.7)	178(12.0)	175(7.3)	-
now[n(%)]	318(10.8)	146(9.9)	204(8.4)	-
BMI(kg/m²)	25.77±4.55	25.84±4.35	25.78±4.69	0.917
SBp (mmHg)	124.02±21.03	128.22±22.47	130.76±22.54	＜0.001
DBp (mmHg)	76.99±14.72	76.39±14.02	75.63±13.75	0.002
Heart rate	85.99±17.47	83.59±17.30	81.89±16.89	＜0.001
EF(%)	32.89±5.79	44.35±2.37	59.58±5.74	＜0.001
BNP(pg/mL)	1340.00(513.89,2697.50)	774.76(280.00,1612.88)	409.00(152.00,1240.87)	＜0.001
NT-Pro BNP(pg/mL)	3794.40(1695.00，7693.10)	2590.00(971.03，5794.75)	1279.50(449.85，3407.33)	＜0.001
NYHA Heart Function Classification[n(%)]				＜0.001
II	1149(20.6)	415(28.0)	711(29.6)	-
III	1510(51.3)	790(53.4)	1390(57.7)	-
IV	827(28.1)	275(18.6)	307(12.7)	-
Coronary revascularization [n(%)]	187(6.3)	109(7.4)	199(8.3)	0.020
Atrial fibrillation/flutter[n(%)]	542(18.4)	333(22.5)	768(31.9)	＜0.001
CRT-D/CRT-P[n(%)]	90(3.1)	15(1.0)	4(0.1)	＜0.001
ICD[n(%)]	60(2.0)	23(1.6)	7(0.3)	＜0.001
Single-chamber/dual-chamber pacemaker	164(5.6)	64(4.3)	96(4.0)	0.086
Diabetes[n(%)]	859(29.2)	521(35.2)	731(30.4)	＜0.001
Stroke/TIA[n(%)]	21(0.7)	20(1.4)	41(1.7)	0.015
Hb(g/L)	135.50±22.56	132.19±21.93	128.91±23.20	＜0.001
Anemia[n(%)]	574(20.9)	336(24.4)	656(29.7)	＜0.001
Blood creatinine(μmol/L)	84.00(69.00，105.00)	81.00(66.50,104.00)	79.00(64.00,101.00)	0.230
CKD[n(%)]	286(9.7)	152(10.3)	242(10.0)	0.813
Blood sodium(mmol/L)	138.88±4.29	139.40±8.12	138.99±4.38	0.011
Hyponatremia[n(%)]	400(13.8)	165(11.5)	291(12.6)	0.079
Serum potassium(mmol/L)	4.13±0.49	4.13±0.49	4.08±0.49	＜0.001
Hypokalemia[n(%)]	235(8.1)	111(7.7)	209(9.0)	0.326
COPD[n(%)]	320(10.9)	158(10.7)	374(15.5)	＜0.001
Abnormal thyroid function[n(%)]	237(8.0)	105(7.1)	209(8.7)	0.439
Malignant tumor[n(%)]	41(1.4)	19(1.3)	51(2.1)	0.162
Blood uric acid(μmol/L)	416.10(323.00，525.95)	370.05(295.00,465.00)	352.00(276.00,444.50)	＜0.001
Hospitalization days	8.00(6.00,10.00)	8.00(6.00,10.00)	8.00(6.00,10.00)	0.973
Hospital deaths (number)	28(1.00)	16(1.10)	19(0.80)	0.637

Table 3 Standardized medication status of patients with HFrEF

drug	n	Xinjiang （n=2946）	n	provincial top-level hospitals（n=1239）	n	Municipal top-level hospitals（n=1707）	P*
Renin-Angiotensin System Inhibitor[n(%)]	2803	2556(91.19)	1208	1107(91.6)	1595	1449(90.8)	0.253
ACEI[n(%)]		1454(56.89)		606(50.2)		848(53.2)	0.062
ARB[n(%)]		822(32.16)		478(39.6)		344(21.6)	＜0.001
ARNI[n(%)]		669(26.16)		279(23.1)		390(24.5)	0.215
β-receptor blockers[n(%)]	2849	2597(91.15)	1215	1113(91.6)	1634	1484(90.8)	0.254
Aldosterone receptor antagonist[n(%)]	1527	1389(90.96)	582	521(89.5)	945	868(91.9)	0.074
Diuretics[n(%)]	2946	2352(79.84)	1239	894(72.2)	1707	1458(85.4)	＜0.001
Digoxin[n(%)]	2946	779(26.44)	1239	254(20.5)	1707	525(30.8)	＜0.001
Qili[n(%)]	2946	192(6.52)	1239	100(8.1)	1707	92(5.4)	0.002

No competing interests reported.

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Analysis of clinical characteristics, diagnosis and treatment status of hospitalized patients with chronic heart failure in Xinjiang,China

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