Heart failure in China: a macroeconomic modelling study of intervention strategies

Heart failure (HF) imposes a growing public health and macroeconomic burden in low- and middle-income countries (LMICs), yet its long-term economic impact remains unquantified. China, characterized by rapid ageing and escalating cardiovascular risks, provides a critical setting to model HF economic implications.

Using data from the Global Burden of Disease Study 2021, China Cardiovascular Association Registry, and national insurance databases, HF macroeconomic burden (2025–35) was projected via a health-augmented macroeconomic model. Three interventions were evaluated: B-type natriuretic peptide (BNP) screening (adults ≥40 years), intensive blood pressure (BP) control (hypertensive patients), and guideline-directed medical therapy (GDMT) optimization for HF with reduced ejection fraction. Costs are reported in 2017 international dollars (INT$).

By 2035, HF cases in China will reach 22.7 million [95% uncertainty interval (UI): 9.5–36.9 million], with an age-standardized prevalence of 760.65/100 000 (95% UI: 283.2–1340.8/100 000). The cumulative economic burden (2025–35) is INT$1001.1 billion (95% UI: 733.4–1365.6 billion), representing 0.26% of gross domestic product (95% UI: 0.19%–0.34%), driven by labour force attrition (72.1%; 95% UI: 64.4%–74.8%). Interventions reduced the total burden by 12.5% (95% UI: 10.4%–14.5%): BNP screening (25% coverage) saved INT$78.5 billion (95% UI: 62.8–94.1 billion; 8.10% reduction; cost-benefit ratio 0.49), Intensive BP control saved INT$27.5 billion (95% UI: 25.1–29.9 billion; 2.74% reduction; ratio 0.22), GDMT optimization saved INT$17.0 billion (95% UI: 12.8–22.4 billion; 1.70% reduction; ratio 0.48).

HF imposes a substantial and increasing macroeconomic burden in China, largely through workforce productivity losses. Scalable, cost-effective strategies, including primary care-based BNP screening, subsidized hypertension control, and enhanced GDMT adherence, are essential to curb economic losses. These findings inform policy priorities for China and other LMICs confronting demographic transitions.