Changing patterns of heart failure in China from 1990 to 2021: a secondary analysis of the Global Burden of Disease study 2021

Abstract Background Heart failure is a leading public health issue in China, with a steadily increasing burden. This study aims to assess the changing patterns of heart failure in China from 1990 to 2021, providing evidence for informed healthcare strategies. Methods Data on prevalence, years lived with disability (YLDs), and their corresponding 95% uncertainty intervals (UI) were obtained from the Global Burden of Disease (GBD) Study 2021. The joinpoint regression model was used to identify both overall and localized trends of heart failure burden, and the age-period-cohort model served to analyze the contributions of age, period, and birth cohort separately. We further utilized the autoregressive integrated moving average (ARIMA) model to predict future trends of heart failure in the next 10 years. Results In 2021, 13099727 (95% UI, 11320895 to 15376467) individuals lived with heart failure and this illness accounted for 1290810 (95% UI, 865894 to 1775731) YLDs in China. The burden of heart failure is more pronounced in males and the elderly, and ischemic heart disease has become the leading cause since 2002. The age-standardized rates of prevalence and YLDs increased at average annual percentage changes of 0.23% (95% CI, 0.20 to 0.26) and 0.25% (95% CI, 0.23 to 0.27) respectively. The curve of local drift showed a downward trend with age. Both the period and cohort rate ratios have increased significantly over the last 30 years. By 2031, the age-standardized rates of prevalence will decrease to 678.69 (95% CI, 640.75 to 716.63), while the age-standardized rates of YLDs will increase to 69.19 (95% CI, 66.95 to 71.43). Conclusions The burden of heart failure in China remains concerning. The implementation of comprehensive strategies should be taken into consideration, including strengthening primary healthcare system, enhancing public awareness, and promoting cardiac rehabilitation. Clinical Perspective What Is New? This is the first study of the Global Burden of Disease (GBD) 2021 that comprehensively analyzes the burden of heart failure in China over the past 30 years. What Are the Clinical Implications? The burden of heart failure in China remains concerning. Comprehensive strategies prioritizing primary healthcare system, public awareness, and cardiac rehabilitation could be effective to mitigate the burden of heart failure.