JANUARY 2015 V OLUME 2, N UMBER 1 NEWS DIGEST I N THIS ISSUE NEWS DIGEST ...................1 ■ China needs to improve PCI accessibility ■ CFDA amends pravastatin sodium instruction ■ China to release drug price control COMPANY FOCUS ............3 ■ Pfizer and Anzhen Hospital to set up cardiovascular big data center ■ Google Project glass used in operation demonstration ■ Lepu Medical to increase stakes in Qinming Medical ■ Trials show positive results for OrbusNeich’s stent ■ MicroPort Castor selected as key project of national program HOSPITAL FOCUS ............5 ■ Anzhen Hospital cooperates with San Donato Group ■ Infantile myxoma operated Xijing Hospital ■ Zhejiang No. 2 Hospital performs “Parachute” surgery ■ 3D printing used in left atrial appendage closure in Shanghai CLINIAL PRACTICE ........6 ■ Researchers report rare giant blood cyst from bicuspid aortic valve ■ Study shows admission useful in predicting short-term outcomes of STEMI patients ■ Study shows the association between NC and early stage atherosclerosis ■ Research shows M2.5 concentration was associated with IHD morbidity and mortality REGULATORY REVIEW ..8 ■ Chinese Expert Consensus for Diagnosis and Treatment of Syncope: 2014 Updated Version ■ Registration of imported vascular stents in SFDA, 2013 & 2014 MARKET REPORT..........10 ■ China cardiovascular mortality on the rise POC PROFILE .................. 11 ■ Peking University First Hospital ■ Peking University People’s Hospital ■ West China Hospital KOL PROFILE ..................14 ■ Huo Yong ■ Hu Dayi ■ Huang Dejia MARKET DATA................17 ■ Ranking of cardiologists in Shanghai ■ Medical insuarance for cardiac products in China ■ Top 100 hospitals by RFCA procedure volume in China (2013) China needs to improve PCI accessibility Despite the fast growth of percutaneous coronary interventinon (PCI) procedure volumes over the recent years, China needs to give more acute myocardial infarction patients access to PCI. The national PCI registry showed that the only 30% of acute STEMI patients recieved PCI treatment within 12 hours after the onset, compared with 88% in the United States. “It is estimated that on China’s mainland, less than 5% of STEMI patients can receive early-stage revascularization,” said Huo Yong, the leader of cardiovascular disease diagnosis and treatment technology management expert team under the National Health and Family Planning Commission. He said that direct PCI should be applied in STEMI patients in some grade two hospitals and county hospitals. This can reduce the imbalance of PCIs in China’s hospitals. According to the national PCI registry, one third of the PCI procedures were conducted in 5% of the hospitals, while 5% of PCI procedures in one third of the hospitals. On the other hand, about 80% of the patients in China received PCI due to acute coronary syndromes, 3/4 of whom suffered unstable angina. These patients have a lower risk and many of them do not need to take PCI, so the reasonable use of PCI is also a challenging task in China, according to Huo. Furthermore, China’s cardiologists should pay more attention to cardiac rehabilitation and second prevention, Huo said. In 2013, over 3,000 physicians in 1,137 hospitals performed 454,505 PCI procedures, compared with 388,836 in 2012 and 332,992 in 2011. And the mortality rate was 0.26% in 2013. Cardiovascular
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JANUARY 2015 VOLUME 2, NUMBER 1
NEWS DIGEST
IN THIS ISSUENEWS DIGEST ...................1■ China needs to improve PCI accessibility■ CFDA amends pravastatin sodium
instruction■ China to release drug price control COMPANY FOCUS ............3■ Pfizer and Anzhen Hospital to set up
cardiovascular big data center■ Google Project glass used in operation
demonstration ■ Lepu Medical to increase stakes in
Qinming Medical■ Trials show positive results for
OrbusNeich’s stent■ MicroPort Castor selected as key project
of national programHOSPITAL FOCUS ............5■ Anzhen Hospital cooperates with San
“Parachute” surgery■ 3D printing used in left atrial appendage
closure in Shanghai CLINIAL PRACTICE ........6■ Researchers report rare giant blood cyst
from bicuspid aortic valve■ Study shows admission useful in
predicting short-term outcomes of STEMI patients
■ Study shows the association between NC and early stage atherosclerosis
■ Research shows M2.5 concentration was associated with IHD morbidity and mortality
REGULATORY REVIEW ..8■ Chinese Expert Consensus for Diagnosis and
Treatment of Syncope: 2014 Updated Version■ Registration of imported vascular stents in
SFDA, 2013 & 2014MARKET REPORT..........10■ China cardiovascular mortality on the rise POC PROFILE ..................11■ Peking University First Hospital■ Peking University People’s Hospital■ West China HospitalKOL PROFILE ..................14■ Huo Yong ■ Hu Dayi ■ Huang DejiaMARKET DATA ................17■ Ranking of cardiologists in Shanghai ■ Medical insuarance for cardiac products
in China■ Top 100 hospitals by RFCA procedure
volume in China (2013)
China needs to improve PCI accessibilityDespite the fast growth of percutaneous coronary interventinon (PCI) procedure volumes over the recent years, China needs to give more acute myocardial infarction patients access to PCI.
The national PCI registry showed that the only 30% of acute STEMI patients recieved PCI treatment within 12 hours after the onset, compared with 88% in the United States.
“It is estimated that on China’s mainland, less than 5% of STEMI patients can receive early-stage revascularization,” said Huo Yong, the leader of cardiovascular disease diagnosis and treatment technology management expert team under the National Health and Family Planning Commission.
He said that direct PCI should be applied in STEMI patients in some grade two hospitals and county hospitals. This can reduce the imbalance of PCIs in China’s hospitals. According to the national PCI registry, one third of the PCI procedures were conducted in 5% of the hospitals, while 5% of PCI procedures in one third of the hospitals.
On the other hand, about 80% of the patients in China received PCI due to acute coronary syndromes, 3/4 of whom suffered unstable angina. These patients have a lower risk and many of them do not need to take PCI, so the reasonable use of PCI is also a challenging task in China, according to Huo.
Furthermore, China’s cardiologists should pay more attention to cardiac rehabilitation and second prevention, Huo said.
In 2013, over 3,000 physicians in 1,137 hospitals performed 454,505 PCI procedures, compared with 388,836 in 2012 and 332,992 in 2011. And the mortality rate was 0.26% in 2013.
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China Food and Drug Administration (CFDA) announced on November 27 ordering that the instructions of pravastatin sodium tablet and capsule shall be amended.
Accoding to the annoucment, the following instructions will be added: “There is the lack of sufficient evidence to prove that any HMG CoA reductase inhibitors will not increase new diabetes risk on susceptible people. It is suggested that clinical manifestations and biochemical indexes related to glucose metabolic disorder should be monitored before and during treatment with statins.”
Pravastatin sodium increases rate at which body removes cholesterol from blood and reduces production of cholesterol in body by inhibiting enzyme that catalyzes early rate-limiting step in cholesterol synthesis.
CFDA asked the manufacturers to amend the instructions within the 6 months after the annoucent was issued.
China to release drug price control China plans to scrap retail price caps on all drugs as early as the start of next year, according to state media.
The National Development and Reform Commission, China’s planning agency, has prepared a draft law for review
by the industry and could lift the caps as early as Jan. 1.
The draft rules, which were sent to eight industry bodies seeking feedback, propose to “cancel government-set prices on drugs, and through insurance price controls and the tendering process, allow the actual transaction price of drugs to be set by market competition,” the newspaper said.
Prices would be set by a combination of health insurance departments, existing tendering processes and multi-stakeholder negotiations, it said.
The caps, however, play only a limited role in the government’s price control regime, analysts said, with around two-thirds of drugs still sold in China’s vast hospital network where prices are kept low through a tendering system.
The full removal of caps should ease price pressures on both domestic and international pharmaceutical firms hoping to tap a healthcare market that McKinsey & Co estimates will grow to $1 trillion by 2020, nearly triple its size in 2011.
China removed price caps on a limited number of drugs in April after criticism that its controls had caused shortages of a number of critical drugs used by millions of patients to treat hyperthyroidism and other ailments.
COMPANY FOCUSCOMPANY FOCUSPfizer and Anzhen Hospital to set up cardiovascular big data centerPfizer and Beijing Anzhen Hospital Affiliated to Capital Medical University, China’s top cardiovascular hospital, have signed an agreement to set up the cardiovascular big data center, the hospital announced.
The agreement lasts for five years, during which the two sides will jointly establish Anzhen-Pfizer Cardiovascular Big Data Center.
The center is about to launch a series of data mining and analysis project, including clinical safety evaluation of commonly used cardiovascular drugs, building the model of predicting the risk of cardiovascular diseases, monitoring of cardiovascular patients hospitalization and death, cardiovascular medical quality assessment and
feedback system, cost benefit analysis of cardiovascular disease diagnosis and treatment, etc. The center will organize activities concerning big data technology research and development and promote the domestic and international medical exchange of the large data.
“Based on the medical data of 4.7 million Beijing residents, we plan to create the interface between cardiovascular disease database and the medical management information, medical insurance information of the Beijing public health information center,” said Professor Ma Changsheng, Director of Cardiology Department of Anzhen Hospital. “We will gradually expand the data sources and conduct the application research on the big data platform.”
The two sides did not disclose the investments which will be placed into the project.
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Google Project glass used in operation demonstration
The Google project glass was used in an operataion demonstration in the Second Affiliated Hospital of Zhejiang University School of Medicine, a top hospital in economically developed Zhejiang province in China.
The hospital’s department of cardiology recently held a pacemaker-implanted technique demonstration and exchange meeting, which attracted doctors around Zhejiang province.
Dr. Xiang Meixiang, Vice Secretary of SAHZU Party Committee, delivered a lecture on axillary venipuncture and capsule active electrode and demonstrated the operation.
The Google project glass was used in such a demonstration for the first time in Zhejiang.
Released by Google on April 5 this year, the glass can “expand the reality”, which means that doctors who wear the glass can broadcast the live show to the medical students. Also, the operation can be rebroadcasted and recorded at the same time.
Although it still has some limits such as time delay, the application of glass facilitates teaching and academic exchanges to a great extent, the hospital’s announcement said.
Lepu Medical to increase stakes in Qinming Medical
Lepu Medical announced on Nov. 15 that it plans to acquire 51% stakes in Xindonggang Pharma for RMB 576.3 million.
Xindonggang is one of the largest Statins APIs manufacturers in the world, whose customers include 11 of the 15 world’s leading generic drugs manufacturers. Xindonggang is also one of the four domestic companies which have obtained production approval for Atorvastatin preparations.
Atorvastatin is a member of the drug class known as statins, which are used primarily for lowering blood cholesterol and for prevention of events associated with cardiovascular disease. Like all statins, atorvastatin works by inhibiting HMG-CoA reductase, an enzyme found in liver tissue that plays a key role in production of cholesterol in the body.
As Xindonggang has a big say in the Statins APIs market, it will show an advantage in the market of Atorvastatin preparations, Lepu Medical said.
Pfizer’s Lipitor sales dropped sharply after 2012 when generic Atorvastatin preparations were launched into the market.
This deal will enable Lepu to expand its business from the cardiac medical devices to the cardiac drugs sector. And Lepu said that it can integrate the sales network of the both sides to increase sales efficicency.
Trials show positive results for OrbusNeich’s stentLatest data presented on the COMBO Dual Therapy Stent provides further evidence to support the long-term safety and efficacy of the stent in the treatment of coronary artery disease, OrbusNeich announced.
The COMBO Dual Therapy Stent is the first dual therapy stent to both accelerate endothelial coverage and control neo-intimal proliferation through the combination of the proven Pro-Healing Technology with an abluminal sirolimus drug elution delivered from a bioresorbable polymer that is completely dissipated within 90 days.
The latest results demonstrate the healing benefits of the COMBO Stent, with data supporting early stent coverage and control of neo-intimal proliferation.
Key findings from the EGO COMBO and REMEDEE First in Man (FIM) trials were presented on October 16th, at the 35th Congresso Nazionale della Societa’ Italiana di Cardiologia Invasiva (GISE) conference in Genoa, Italy by Prof. Giuseppe De Luca, of the Eastern Piedmont University in Novara, Italy.
“Clinical data gathered from the trials to date is very encouraging, particularly around the unique 24month neointima regression phenomenon,” said Prof. De Luca. “This new data validates what we have seen in clinical practice and illustrates the COMBO Stent’s ability to deliver long-term true vessel healing.”
Prof. De Luca, Co-Principal Investigator of the REDUCE trial, also announced the initiation of this multicenter trial designed to evaluate the potential for shorter-term dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients. REDUCE will for the first time evaluate
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HOSPITAL FOCUSHOSPITAL FOCUSAnzhen Hospital cooperates with San Donato GroupBeijing Anzhen Hospital Affiliated to Capital Medical University recently signed the cardiovascular disease research cooperation agreement with San Donato Group of Italy.
Under the agreement, the two sides will be jointly committed to the cultivation of the young physician and the research of new cardiovascular disease treatment technology.
The two sides started the earlist exchanges in the 1990s.
Wei Yongxiang director of the hospital was among the Chinese delegation to Italy, led by Premier Li Keqiang. This is the only cooperative project in the healthcare sector signed during the premier’s trip to Italy.
Infantile myxoma operated Xijing HospitalSurgeons at Xijing Hospital’s cardiac surgery department conducted a successful surgery on a one-month-old premature child (born at 7 months in the womb) of cardiac
myxoma combined with congenital heart disease, Xijing Hospital announced on November 28.
Examinations showed that the tumor was located near the tricuspid valve, and may cause acute tricuspid infarction at any time. Myxoma is easy to fall off, which may easily cause pulmonary infarction blood vessels or metastasis.
The department discussed many times and decided to conduct three procedures: myxoma excision, auricular septal defect repair and ligation of patent ductus arteriosis.
Doctor Gu Chunhu and other doctors spent one hour and 48 minutes completing the surgery. A 2cm myxoma was removed and congenital heart disease was treated. The baby recovered after ICU treatment.
Myxoma is a common cardiac tumor for adults, but rarely seen in infants. Only 5 infantile myxoma cases have been reported in the world. The first infantile myxoma was conducted in U.S.A. in 1965.
Zhejiang No. 2 Hospital performs first
the safety of shorter (three months) DAPT in ACS patients with the COMBO Stent across centers in Europe and Asia. “I believe that the unique EPC technology featured on the COMBO Stent may safely enable us to reduce the duration of DAPT and, as a result, decrease the risk of bleeding and ensure high compliance among patients,” said Prof. De Luca.
OrbusNeich is a global company that designs, develops, manufactures and markets innovative medical devices for the treatment of vascular diseases.
MicroPort Castor selected as key project of national programCastor Thoracic Branch Stent-Graft System, an endovascular device developed by MicroPort Endovascular (Shanghai) Co., was successfully selected as one project of the National Key Technology R&D Program for China’s 12th Five-Year Plan in November.
Compared with other branch stent-grafts under
development, Castor has less endoleak and better branch artery patency. It also features kink-free outer sheath, arch-passing ability, soft membrane as well as soft cap with branch stent cramped in.
During the past decade, an increasingly more people suffer from thoracic dissection in China. Dissection involving left subclavian artery is currently a relative contraindication for endovascular treatment. In that case, the development of Castor is a crucial milestone in treatment of challenging aortic arch disease.
MicroPort has carried out clinical trials for Castor, which is the world’s first large-scaled and multi-centered clinical study for branched thoracic stent graft. Its clinical efficacy has gained recognitions from domestic medical professionals.
MicroPort Endovascular (Shanghai) Co. is a subsidiary of Shanghai MicroPort Medical (Group) Co., a medical device company with business focusing on innovating, manufacturing, and marketing medical devices globally.
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CLINICAL PRACTICECLINICAL PRACTICE
“Parachute” surgery in ZhejiangThe cardiovascular team of the Second Affiliated Hospital of Zhejiang University School of Medicine performed the “parachute” minimally invasive surgery on patients who suffered from ventricular aneurysm.
Led by the hospital’s President WangJian’an, this kind of operation was done for the first time in Zhejiang Province.
Mr. Li, a 35 year-old man working at a mold factory in Wenling, suffered from myocardial infarction half a year ago. After assessment and discussion, doctors decided to adopted the “parachute” surgery by which the patient is installed a “parachute-like” isolation device in his left ventricle. This device will separate the abnormally-shrinking room wall, reducing the volume of left ventricle and improving the syndrome and cardiac function.
This “parachute” is a frame made up by 16 hair-like supports. Wang’s team employed minimally invasive technique to put the “parachute” into the tip of the patient’s left ventricle through his arteries.
There were two other patients who was performed the same operation on the same day, one at the age of 79, another 77. It was said that the “parachute” surgery, which
enjoys a domestic leading position, is new in Europe and America. The heart center of SAHZU is one of few centers in the world which can perform this surgery.
3D printing used in left atrial appendage closure in Shanghai
Professor He Ben from Shanghai Renji Hospital recently conducted the left atrial appendage closure on two patients with the help of 3D printing technology.
Support by the cardiovascular imaging team, He first collected the CT scan image of the patient, and then used 3D printer to make two left atrial appendage models of the two patients.
Based on the 3D printed models, the professor and his team made a plan and spent 4 hours to conduct the left atrial appendage closure operations.
During the operation, the imaging team provided 4D cardiac color ultrasound to provide convenience.
“3D printing helped us to ascertain the condition and prepare the plan, thus improving the surgery success; at the same time, it helps shorten the learning curve of doctors to master new clinical skills,” the professor said.
Researchers report rare giant blood cyst from bicuspid aortic valveProfessor Zhang Eryong from West China Hospital, Sichuan University and his team recently reported a giant blood cyst originating from the bicuspid aortic valve.
A 22-year-old male patient was admitted to the hospital because of repeated chest pain and syncope. Physical examination was unremarkable except for a systolic murmur on cardiac auscultation. Transesophageal echocardiogram showed a large, very mobile cystic mass (21×17 mm) attaching to the bicuspid aortic valve, which caused severe left ventricular outflow tract obstruction with normal ventricular size and function.
Additional cardiac MRI revealed there was a cyst-like mass attached on the aortic valve (Figure 1C through 1E and
Movie III in the online-only Data Supplement). Finally, a bluish blood-filled cyst (23×17 mm) originating from the bicuspid aortic valve with a broad base was confirmed during surgical operation. Surgical resection of the cyst with concurrent aortic valve replacement was done for this patient. Additional histological examination confirmed that the cystic cavity was surrounded by a fibromyxoid wall with an internal lining of endothelial cells. The patient was discharged uneventfully 7 days after surgery.
Study shows admission useful in predicting short-term outcomes of STEMI patients
Admission Shock Index, an easily calculated index at first contact, may be a useful predictor for short-term outcomes especially for acute phase outcomes in patients with STEMI, according to a study of Professor YangYanmin
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and her colleagues from Beijing Fuwai Hospital published recently.
Included in the study were 7,187 consecutive patients with STEMI. The admission SI was defined as the ratio of admission heart rate and systolic blood pressure. Patients were divided into 2 groups with SI <0.7 and ≥0.7, respectively, based on the receiver operating characteristic curve analysis. The major end points were 7- and 30-day all-cause mortality.
Of 7,187 patients, 5,026 had admission SI <0.7 and 2,161 had admission SI ≥0.7. Those who presented with SI ≥0.7 had greater 7- and 30-day all-cause mortality and major adverse cardiovascular events than patients with SI <0.7. After multivariate adjustment, patients with SI ≥0.7 had a 2.2-fold increased risk of 7-day all-cause mortality (hazard ratio 2.21, 95% confidence interval [CI] 1.71 to 2.86) and 1.9-fold increased risk of 30-day all-cause mortality (hazard ratio 1.94, 95% CI 1.54 to 2.44).
Moreover, admission SI ≥0.7 was also associated with 1.6- and 1.5-fold increased risk of 7- and 30-day major adverse cardiovascular events (hazard ratio 1.63, 95% CI 1.36 to 1.95 and hazard ratio 1.47, 95% CI 1.24 to 1.74, respectively). The C statistic of admission SI for predicting 7- and 30-day all-cause mortality was 0.701 and 0.686, respectively, compared with 0.744 and 0.738 from the Thrombolysis in Myocardial Infarction risk score.
Study shows the association between NC and early stage atherosclerosis
High neck circumference is associated with an increased risk of early stage atherosclerosis in Chinese adults, according to a study by Professor Liang Jun from Xuzhou Central Hospital Affiliated to Southeast University and his team.
The study samples were from a community-based health examination survey in central China. In total 2,318 men and women (18-64 y) were included in the final analyses. Carotid radial pulse wave velocity (crPWV), carotid femoral PWV (cfPWV), carotid artery dorsalis pedis PWV (cdPWV) and NC were measured.
After adjustment for age, sex, lipids, glucose, blood pressure, heart rate, body mass index (BMI), high NC was significantly associated with an increasing trend of cfPWV, cdPWV and
crPWV (P = 0.001, 0.049, and 0.038; respectively).
In addition, the researchers found significant interaction between hypertension status and NC level in relation to cfPWV, adjusted for age, sex, BMI, fasting glucose, lipids and heart rate(P for interaction = 0.034). The associations between NC and cfPWV were significant (P = 0.02) among those with hypertension, but not significant among those without hypertension.
Neck Circumference (cm) was measured with head erect and eyes facing forward, horizontally at the upper margin of the laryngeal prominence with a flexible tape.
Research shows M2.5 concentration was associated with IHD morbidity and mortality
M2.5 concentration was significantly associated with IHD morbidity and mortality in Beijing, according to a research by Professor Zhao Dong from Beijing Anzhen Hospital and his team.
A time-series study conducted in Beijing from 1 January 2010 to 31 December 2012. Data on 369 469 IHD cases and 53 247 IHD deaths were collected by the Beijing Monitoring System for Cardiovascular Diseases, which covers all hospital admissions and deaths from IHD from Beijing’s population of 19.61 million.
The mean daily PM2.5 concentration was 96.2 μg/m3 with a range from 3.9 to 493.9 μg/m3. Only 15.3% of the daily PM2.5 concentrations achieved WHO Air Quality Guidelines target (25 μg/m3) in the study period. The dose–response relationships between PM2.5 and IHD morbidity and mortality were non-linear, with a steeper dose–response function at lower concentrations and a shallower response at higher concentrations. A 10 μg/m3 increase in PM2.5 was associated with a 0.27% (95% CI 0.21 to 0.33%, p<2.00×10−16) increase in IHD morbidity and a 0.25% (95% CI 0.10 to 0.40%, p=1.15×10−3) increase in mortality on the same day.
During the 3 years, there were 7703 cases and 1475 deaths advanced by PM2.5 pollution over expected rates if daily levels had not exceeded the WHO target.
The findings provide a rationale for the urgent need for stringent control of air pollution to reduce PM2.5 concentration.
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REGULATORY REVIEWREGULATORY REVIEWChinese Expert Consensus for Diagnosis and Treatment of Syncope: 2014 Updated Version
The new Chinese expert consensus for diagnosis and treatment of syncope consists of the following parts:
1. Classification and pathophysiology;
(1) Definition
(2) Classification
(3) Pathophysiology
2. Diagnosis and risk stratification;
(1) Preliminary assessment
(2) Diagnosis
(3) Risk stratification
(4) Auxiliary examinations
3. Treatment;
(1) General principle
(2) Reflex syncope
(3) Orthostatic hypotension and orthostatic intolerance syndrome
(4) Cardiac syncope
4. Special problems;
(1) Senile syncope
(2) Syncope in children
(3) Driving and syncope
5. Hospital department recommended for patient admission.
6. Appendix: head-up tilt test (HUTT).
Compared with the 2008 Chinese expert consensus for syncope diagnosis and treatment, modifications were made in the new version as below:
1. Orthostatic intolerance syndrome was added into the class of orthostatic syncope;
2. Arrhythmias syncope and syncope caused by organic heart disease was combined as one class, cardiac syncope;
3. In the subclassification of reflex syncope, hyperirritable carotid sinus syndrome was listed as one independent subclass for the first time;
4. The characteristics of orthostatic syncope was more specifically described;
5. For the diagnostic criteria of arrhythmias syncope, sinus bradycardia was changed from HR<50/min to <40/min, and atrioventricular block from type I second-degree A-V block to type II second-degree A-V block, or third-degree A-V block;
6. Diagnostic criteria for syncope caused by organic heart disease was listed independently;
7. Risk stratification was recommended for those with uncertain diagnosis of syncope;
8. Carotid sinus massage (CSM) and assessment for upright position was listed as the first two auxiliary examination;
9. For treatment of reflex syncope, physical counter-pressure movement (PCM) was mentioned as first-line therapy for the first time;
10. Discussion of heritable ion channel disease was deleted from treatment of arrhythmias syncope;
11. Specific indications for implantable cardioverter-defibrillator (ICD) implantation for patients with high risk for cardiac sudden death (syncope with unclear reason);
12. 24 hour ambulatory blood pressure monitoring was firstly recommended for senile syncope patients suspected with unstable blood pressure;
13. Children syncope was firstly classified into two specific subclass: infant reflex syncope attack and transient loss of consciousness caused by asphyxial hypoxia;
14. Hospital department recommended for patient admission was firstly listed;
15. Details for head-up tilt test (HUTT) were independently listed as the appendix.
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Registration of imported vascular stents in SFDA, 2013 & 2014(Source: China Cardiovascular Business, based on government data)
Name of stent Manufacturer Country Expiration date Use
LifeStent and LifeStent XL Vascular Stent Angiomed GmbH & Co. Medizintechnik KG
GORE EXCLUDER AAA Endoprosthesis W.L. GORE & ASSOCIATES, INC. U.S.A. 2017.08.26 Abdominal aorta diseases
Coronary Stent System Biotronik AG U.S.A. 2017.08.19 Coronary artery diseases
Taxus Liberté Paclitaxel-Eluting Coronary Stent System
Boston Scientific Corporation U.S.A. 2017.02.21 Coronary artery diseases
PROMUS Element Plus Everolimus-Eluting Coronary Stent System
Boston Scientific Corporation U.S.A. 2017.01.14 Coronary artery diseases
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MARKET REPORTMARKET REPORTChina cardiovascular mortality on the rise According to China Cardiovascular Disease Report 2013, there are currently about 290 million cardiovascular disease patients in China, compared with 230 million cardiovascular disease suffers two year before, showing a rising trend. About one in every five adults is a cardiovascular disease sufferer.
Of the 290 million cardiovascular disease patients, 270 million suffer from hypertension, 7 million stroke, 2.5 million myocardial infarction, 4.5 million heart failure, 5 million pulmonary heart disease, 2.5 million rheumatic heart disease, 2 million congenital heart disease.
The national disease surveillance system showed that the mortality of cardiovascular disease rose from 240.03/100,000 in 2004 to 268.92/100,000 in 2010. This was mainly due to the rise in ischemic heart disease deaths. The mortality rates of ischemic heart disease, hypertensive heart disease, and cerebrovascular disease rose 5.05%, 2.08% and 1.02% respectively during the six years, while the rheumatic heart disease mortality dropped 7.02% year on year.
Cerebrovascular disease
Cerebrovascular disease prevalence in China is on the rise. The morbidity for city residents is higher than the rural residents. Ischemic stroke accounted for 66.4%, cerebral hemorrhage, accounted for 23.4%.
From 2003 to 2011, the cerebrovascular disease mortality for China’s rural residents was higher than urban residents. In 2011, cerebrovascular disease mortality was 125.37/10 for urban residents, and 136.68/10 for rural residents. Based on China’s Sixth Population Census, it can be estimated that 834,500 urban residents and 921,100 rural residents died of cerebrovascular diseases in 2011.
Coronary heart disease
The 2008 China health service survey shows that the ischemic heart disease prevalence was 7.7 ‰ in China (15.9 ‰ in urban area, and 4.8 ‰ in rural area), which increased significantly from 4.6 ‰ showed by the 2003
survey (urban 12.4 ‰, rural 2.0 ‰).
From 2002 to 2011, coronary heart disease mortality rate was on the rise in China. In 2011 coronary heart disease mortality was 95.97/100,000 in urban areas, 75.72/100,000 in rural areas, higher than that for 2010 (86.34/100,000, 69.24/100,000).
Overall, the mortality rate of acute myocardial infarction was on the rise from 2002 to 2011. Starting in 2005, acute myocardial infarction mortality rate in rural areas grew rapidly, and surpassed that in urban areas in 2009, 2010 and 2011. Adjusted for geographic region and sex, myocardial infarction mortality increases with the age - rising sharply on people over 40.
Arrythmia
A retrospective survey on the patients in the cardiac department of 22 provincial hospitals in China showed that 26.8% of hospitalized patients suffered from arrhythmia. Of arrhythmia, atrial fibrillation ranked first (35.0%), followed by paroxysmal supraventricular tachycardia (28.0%), sick sinus syndrome (11.9%) and ventricular premature beat (11.6%).
According to a survey in 2004, atrial fibrillation prevalence was 0.77% in people aged 35 ~ 59 (male 0.78%, female 0.76%). And 19.0% of male AF patients and 30.9% of female AF patients also suffer from heart valve disease. The history of myocardial infarction, left ventricular hypertrophy, obesity, drinking are the risk factors of AF.
Heart failure
According to a survey of 15,518 people in 10 provinces,
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the prevalence of chronic heart failure in people aged 35 to 74 in China is 0.9% - male 0.7%, female 1.0%. The heart failure prevalence grows significantly with the age. Heart failure prevalence in North China is higher than South China (1.4% vs 0.5%), and that for urban areas is higher than rural areas (1.1% vs 0.8%). Over the past thirty years, the chief cause of heart failure changed to coronary heart disease (CHD) from rheumatic valvular heart disease.
Sudden cardiac death (SCD)
The incidence of SCD is 41.8/100,000 for Chinese people. The incidence is 44.6/100,000 for men and 39.0/100,000 for women, which rises significantly with the age. It is estimated that there are 544,000 new SCD cases in China each year.
Pulmonary arterial hypertension
A survey 31 Grade-Three Class-One hospitals in China showed that PAH related to congenital heart disease 49.6%, idiopathic PAH 27.2%, PAH related to connective tissue diseases 11.6% and chronic thromboembolic PAH, 11.6%.
Cardiac surgery
In recent 10 years, cardiac surgery volume was increasing year by year on the Chinese mainland, amounting to 203,195 in 2012. Of these, 158, 597 cases were extracorporeal circulation operations. In 2012, a total of 84,439 cases of congenital heart disease surgery, 218 cases of heart transplantation (including 5 cases of heart and lung transplantation), and 399 cases of extracorporeal membrane oxygenation treatment were conducted on the Mainland and Hong Kong.
Cardio-cerebrovascular disease inpatient visits
In 2012, there were 14.35 million cardio-cerebrovascular disease inpatient visits in China’s hospitals, accounting for
12.24% of the total inpatient visits in China’s hospitals. Among them, there were 7.525 million cardiovascular disease inpatient visits, and 6.8279 million cerebrovascular disease inpatient visits.
In 2012, the ischemic heart disease inpatient visits numbered 5.05 million (295,200 acute myocardial infarction inpatient visits) and cerebral infarction inpatient visits, 4.12 million, accounting for 35.17% and 28.72% respectively. They were followed by high blood pressure, 2.24 million visits; intracranial hemorrhage, 1.20 million visits; rheumatic heart disease, 238,300 visits. About 2.39 million diabetic patients were discharged from hospital.
Cardiovascular diseases inpatients discharged in China, 1980-2012
In 2012, the total hospitalization expenses of acute myocardial infarction were RMB 4.961 billion in China, intracranial hemorrhage, RMB 14.706 billion, and cerebral infarction, RMB 29.845 billion. The average expense per inpatient was RMB 16802.4 for acute myocardial infarction, RMB 12207.4 for intracranial hemorrhage, and RMB 7241.3 for cerebral infarction, increasing 5.78%, 4.80%, and 0.96% year-on-year since 2004.
POC PROFILEPOC PROFILECardiology Department, Peking University First Hospital
Cardiology Department, Peking University People’s Hospital
As a national leader in prevention, diagnosis and treatment of cardiovascular diseases, the cardiology department has lots of “firsts” in China: first Chest Pain Center, first radiofrequency ablation case and first loop recorder placement. Moreover, cardiologists in the department handle
the most cases of cardiovascular implantable electronic device infections in Asia. During the past several years, the department was grant recipients of 21 national projects and three international joint programs. It is now an American Heart Association (AHA) Professional Resource Center.
Top 100 hospitals by RFCA procedure volume in China (2013) *(Source: China Cardiovascular Business)
Hospital Grade Category Province CityHospital
beds
Cardiology department
beds
RFCA cardiologists
RFCA procedure volume in
2013Fuwai Hospital Grade Three Class A Cardiac hospital Beijing Beijing 659 184 18 3680Wuhan Asia Heart Hospital Grade Three Class A Cardiac hospital Hubei Wuhan 500 100 8 2350Shanghai Chest Hospial Grade Three Class A Chest hospital Shanghai Shanghai 676 50 8 2150Guangdong People’s Hospital Grade Three Class A General hospital Guangdong Guangzhou 2053 150 8 2050Beijing Anzhen Hospital Grade Three Class A Cardiac hospital Beijing Beijing 937 136 14 1880West China Hospital Grade Three Class A General hospital Sichuan Chengdu 4091 101 6 1575Zhongshan Hospial Affiliated to Fudan University
Grade Three Class A General hospital Shanghai Shanghai 1530 190 7 1500
Jiangsu People’s Hospital Grade Three Class A General hospital Jiangsu Nanjing 1866 74 8 1230First Hospital Affilated to Zhejiaing University
Grade Three Class A General hospital Zhejiang Hangzhou 1984 80 7 948
Hubei People’s Hospital Grade Three Class A General hospital Hubei Wuhan 1300 80 4 924Shaoyifu Hospital Affilated to Zhejiaing University
Grade Three Class A General hospital Zhejiang Hangzhou 842 34 4 905
Zhengzhou No. 7 People’s Hospital Grade Three Class A Cardiac hospital Henan Zhengzhou 110 50 3 868Second Hospital Affilated to Harbin Medical University
Grade Three Class A General hospital Heilongjiang Harbin 1681 170 4 730
First Hospital Affilated to Zhengzhou University
Grade Three Class A General hospital Henan Zhengzhou 1678 100 6 720
Central South China University Xiangya Second Hospital
Grade Three Class A General hospital Hunan Changsha 2426 85 4 675
Lanzhou UniversityFirst Hospital Grade Three Class A General hospital Gansu Lanzhou 1049 84 7 636Tianjin Chest hospital Grade Three Class A Chest hospital Tianjin Tianjin 449 180 5 625Beijing Chaoyang Hospital Grade Three Class A General hospital Beijing Beijing 1506 135 6 620First Hospital A ffiliated to Guangxi Medical University
Grade Three Class A General hospital Guangxi Nanning 2447 85 4 580
Central South China University Xiangya Hospital
Grade Three Class A General hospital Hunan Changsha 1515 47 5 575
Zhongshan Hospital Affiliated to Xiamen University
Grade Three Class A General hospital Fujian Xiamen 1087 60 4 570
Second Hospital Affiliated to Nanchang University
Grade Three Class A General hospital Jiangxi Nanchang 787 80 6 559
First Hospital Affiliated to Dalian Medical University
Grade Three Class A General hospital Liaoning Dalian 1599 83 4 542
First Hospital Affiliated to Xi’an Jiaotong University
Grade Three Class A General hospital Shaanxi Xi’an 1502 78 6 540
First Hospital Affiliated to Harbin Medical University
Grade Three Class A General hospital Heilongjiang Harbin 2031 45 2 535
Second Hospital Affiliated to Zhejiang University
Grade Three Class A General hospital Zhejiang Hangzhou 1835 100 7 535
Jilin University Second Hospital Grade Three Class A General hospital Jilin Changchun 1159 80 5 530Shanghai Xinhua Hospital Grade Three Class A General hospital Shanghai Shanghai 1178 70 4 518First Hospital Affiliated to China Medical University
Grade Three Class A General hospital Liaoning Shenyang 1436 93 4 495
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Shengjing Hospital Affiliated to China Medical University
Grade Three Class A General hospital Liaoning Shenyang 2853 83 4 477
Shanghai No. 1 Hospial Grade Three Class A General hospital Shanghai Shanghai 1642 110 5 470First Hospital Affiliated to Xinjiang Medical University
Grade Three Class A General hospital Xijiang Urumchi 1933 20 5 470
Henan People’s Hospital Grade Three Class A General hospital Henan Zhengzhou 1877 35 5 455First Hospital Affiliated toChongqing Medical University
Grade Three Class A General hospital Chongqing Chongqing 1700 110 6 455
Jilin University First Hospital Grade Three Class A General hospital Jilin Changchun 1240 90 4 440First Hospital Affiliated to Kunming Medical University
Grade Three Class A General hospital Yunnan Kunming 1301 100 5 435
First Hospital Affiliated to Zhongshan University
Grade Three Class A General hospital Guangdong Guangzhou 2094 45 5 432
Union Hospital Affiliated to Huazhong University of Science and Technology
Grade Three Class A General hospital Hubei Wuhan 1613 50 5 432
Fourth Hospital Affiliated to Harbin Medical University
Grade Three Class A General hospital Heilongjiang Harbin 800 65 5 430
Nanjing GulouHospital Grade Three Class A General hospital Jiangsu Nanjing 1383 90 4 425Wuxi People’s Hospital Grade Three Class A General hospital Jiangsu Wuxi 800 83 2 420Hebei People’s Hospital Grade Three Class A General hospital Hebei Shijiazhuang 931 90 4 415Beijing University People’s Hospital Grade Three Class A General hospital Beijing Beijing 1219 100 6 405First Hospital Affiliated to Suzhou University
Grade Three Class A General hospital Jiangsu Suzhou 1408 75 4 402
Jiangxi People’s Hospital Grade Three Class A General hospital Jiangxi Nanchang 906 40 4 395Shandong Provincial Hospital Grade Three Class A General hospital Shandong Jinan 1749 32 5 395Shandong University Qilu Hospital Grade Three Class A General hospital Shandong Jinan 1598 50 4 390Fujian Provincial Hospital Grade Three Class A General hospital Fujian Fuzhou 1061 120 3 385Shanghai Ruijin Hospial Grade Three Class A General hospital Shanghai Shanghai 1653 100 5 384Shanghai Renji Hospial Grade Three Class A General hospital Shanghai Shanghai 1528 98 4 375Nanjing FirstHospital Grade Three Class A General hospital Jiangsu Nanjing 850 85 3 353South Medical University Southern Hospital
Grade Three Class A General hospital Guangdong Guangzhou 1737 65 4 350
Hebei Medical University Second Hospital
Grade Three Class A General hospital Hebei Shijiazhuang 1327 80 4 350
Shanxin Cardiovascular diseases Hospital
Grade Three Class A Cardiac hospital Shanxi Taiyuan 150 90 3 350
Beijing Union Hospital Grade Three Class A General hospital Beijing Beijing 1808 32 6 346Tongji Hospital Affiliated to Huazhong University of Science and Technology
Grade Three Class A General hospital Hubei Wuhan 2016 40 4 338
Qingdao University Affiliated to Hospital
Grade Three Class A General hospital Shandong Qingdao 1233 80 5 325
Sichuan People’s Hospital Grade Three Class A General hospital Sichuan Chengdu 1803 110 4 324Anhui Provincial Hospital Grade Three Class A General hospital Anhui Hefei 1401 65 5 318Hunan People’s Hospital Grade Three Class A General hospital Hunan Changsha 844 54 4 315Jining First People’s Hospital Grade Three Class A General hospital Shandong Jining 1052 90 4 313Tianjin Medical University Second Hospital
Grade Three Class A General hospital Tianjin Tianjin 734 88 3 301
Tianjin Teda International Cardiovascular Hospital
Grade Three Class A Cardiac hospital Tianjin Tianjin 157 68 3 298
Shenzhen Sun Yet-sen Cardiovascular Hospital
Grade Three Class A Cardiac hospital Guangdong Shenzhen 120 65 3 297
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Henan Chest hospital Grade Three Class A Chest hospital Henan Zhengzhou 507 41 4 297Xuzhou Central Hospital Grade Three Class A General hospital Jiangsu Xuzhou 1200 130 3 285Tianjin Medical University General Hospital
Grade Three Class A General hospital Tianjin Tianjin 1600 94 3 280
Frist Hospital Affiliated to Wenzhou Medical College
Grade Three Class A General hospital Zhejiang Wenzhou 1496 50 2 275
Fujian Medical University Affiliated to Union Hospital
Grade Three Class A General hospital Fujian Fuzhou 1334 100 5 262
Anhui Medical University First Hospital Affiliated to
Grade Three Class A General hospital Anhui Hefei 1822 55 4 261
First Hospital Affiliated to Henan Technology University
Grade Three Class A General hospital Henan Luoyang 1151 70 3 260
Central South China University Xiangya Third Hospital
Grade Three Class A General hospital Hunan Changsha 1000 40 3 260
Zhejiang People’s Hospital Grade Three Class A General hospital Zhejiang Hangzhou 1100 58 6 252Guangxi People’s Hospital Grade Three Class A General hospital Guangxi Nanning 1431 85 3 250Beijing University Thrid Hospital Grade Three Class A General hospital Beijing Beijing 1183 78 5 248Beijing Youyi Hospital Grade Three Class A General hospital Beijing Beijing 892 75 4 248Shanghai East Hospial Grade Three Class A General hospital Shanghai Shanghai 753 60 1 246Ningxia Medical University General Hospital
Grade Three Class A General hospital Ningxia Yinchuan 1215 58 4 245
Shanxi Medical University First Hospital Grade Three Class A General hospital Shanxi Taiyuan 928 70 4 245Chongqing Medical University Second Hospital Affiliated to
Grade Three Class A General hospital Chongqing Chongqing 943 48 5 243
Ningbo First Hospital Grade Three Class A General hospital Zhejiang Ningbo 1004 50 5 240Subei People’s Hospital Grade Three Class A General hospital Jiangsu Yangzhou 1176 63 4 235Hebei Medical University First Hospital Grade Three Class A General hospital Hebei Shijiazhuang 855 60 3 230Tangshan Workers Hospital Grade Three Class A General hospital Hebei Tangshan 1249 60 3 230Second Hospital Affiliated to Xi’an Jiaotong University
Grade Three Class A General hospital Shaanxi Xi’an 872 70 4 230
Shandong Qianfoshan Hospital Grade Three Class A General hospital Shandong Jinan 759 40 3 226Kunming Yanan Hospital Grade Three Class A General hospital Yunnan Kunming 706 100 2 226Second Hospital Affiliated to Zhongshan University
Grade Three Class A General hospital Guangdong Guangzhou 1217 55 3 225
Guizhou People’s Hospital Grade Three Class A General hospital Guizhou Guiyanga 1468 80 2 225Wuxi Second People’s Hospital Grade Three Class A General hospital Jiangsu Wuxi 650 97 4 225Second Hospital Affiliated to Wenzhou Medical College
Grade Three Class A General hospital Zhejiang Wenzhou 1558 100 4 223
Lanzhou University Second Hospital Grade Three Class A General hospital Gansu Lanzhou 800 40 2 220Xijiang People’s Hospital Grade Three Class A General hospital Xijiang Urumchi 1556 80 4 220Beijing Tongren Hospital Grade Three Class A General hospital Beijing Beijing 1530 68 2 216Shanghai No. 10 Hospial Grade Three Class A General hospital Shanghai Shanghai 785 80 3 216First Hospital Affiliated to Fujian Medical University
Grade Three Class A General hospital Fujian Fuzhou 1409 55 5 215
Foshan First People’s Hospital Grade Three Class A General hospital Guangdong Foshan 1443 65 1 215Yantai Liuhuangding Hospital Grade Three Class A General hospital Shandong Yantai 1607 100 3 215Zhejiang Hospital Grade Three Class A General hospital Zhejiang Hangzhou 500 41 4 215Liaoning People’s Hospital Grade Three Class A General hospital Liaoning Shenyang 550 139 4 212
* RFCA short for radiofrequency catheter ablation
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Transmedia CardioChina Service
CardioChina (cardiochina.com) is a service from Transmedia Healthcare, a China-based business intelligence provider for the global life sciences industry.
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China Cardiovascular Business (CCB)
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