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.

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 105 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.