Cardiovascular and cerebrovascular disease is the world's first cause of death, in China, its morbidity and mortality rate also remains high - according to “China's Cardiovascular Health and Disease Report 2022”, China's cardiovascular and cerebrovascular disease patients have reached 330 million people, the number of deaths each year accounted for more than 40% of the total number of deaths. In the face of this serious challenge, China's healthcare system, after decades of development, has formed a mature system covering the whole cycle of “prevention, emergency care, treatment and rehabilitation”, and has demonstrated its unique advantages in terms of innovation in treatment modalities, leadership of leading hospitals, multidisciplinary collaboration, and integration of Chinese and Western medicine.
Treatment Methods
The treatment of cardiovascular and cerebrovascular diseases needs to be formulated according to the type of disease (e.g. coronary heart disease, arrhythmia, stroke, heart failure, etc.), the degree of severity (acute attack/chronic stabilization), and the individual differences of the patients, and is currently divided into the four core directions of first-aid treatment, interventional/surgical treatment, medication, and rehabilitation, which collaborate to form the “golden treatment chain”. All modalities are synergistic to form the “golden treatment chain”.
1. Emergency treatment
The key to the treatment of acute heart attack, cerebral infarction and other acute and critical diseases lies in “early identification, early medical treatment and early opening”. China has established the world's largest network of chest pain centers/stroke centers (by 2023, there will be more than 5,000 hospitals and 1,500 stroke centers accredited by the National Chest Pain Center), and through the integrated model of “pre-hospital emergency care and in-hospital green channel”, the time from admission to balloon dilatation (D2B) of acute heart attack patients has been shortened to less than 60 minutes (90 minutes by international standards), and the time for balloon dilatation (D2B) is less than 90 minutes. Through the integrated model of “pre-hospital emergency care and in-hospital green channel”, the time from admission to balloon dilatation (D2B) of acute heart attack patients has been shortened to less than 60 minutes (compared with 90 minutes in international standards), and in some regions, patients with chest pain can even bypass the emergency department and go directly to the catheterization room, which has significantly reduced the mortality rate. For example, the Chest Pain Center of Fu Wai Hospital in Beijing treats more than 3,000 cases of acute heart attack annually, and the mortality rate has been reduced to less than 2% (the international average is about 5%).
2. Interventional therapy
Interventional therapy is one of the core treatments for cardiovascular and cerebrovascular diseases at present, especially outstanding in the field of coronary heart disease and arrhythmia:
Coronary heart disease: percutaneous coronary intervention (PCI) implanted a stent through a catheter to rapidly open a narrowed or occluded coronary artery. In recent years, domestic biodegradable stents (e.g., LOPE, minimally invasive bioabsorbable stents) have been realized for clinical application, which avoids the disadvantage of traditional metal stents that are “permanently retained in the body”; and the application of intracavitary imaging technology (e.g., OCT, IVUS) makes stent implantation more accurate and reduces the risk of restenosis.
Arrhythmia: Radiofrequency ablation eliminates abnormal pacing points through high-frequency current, and the success rate of the treatment of atrial fibrillation and supraventricular tachycardia is more than 90%; the application of three-dimensional standardized measurement system (e.g., CARTO, EnSite) shortens the operation time from the traditional several hours to 1-2 hours.
3.Surgical treatment
For complex lesions that cannot be treated by interventional therapy (e.g., multibranch vasculopathy, left main lesion, heart valve disease, etc.), surgery is still the key tool:
Coronary artery bypass grafting (bypass surgery): taking one's own blood vessels (e.g., saphenous vein, internal mammary artery) to build a “bridge vessel” to bypass the stenotic coronary arteries. Minimally invasive non-corporeal bypass techniques are well established in large heart centers in China (e.g., Anzhen Hospital, Fu Wai Hospital), resulting in less trauma and faster recovery.
Heart valve repair/replacement: For rheumatic valvular disease and degenerative disease, surgical repair (e.g., mitral valvuloplasty) is better than replacement, preserving the patient's own annular structure; transcatheter aortic valve replacement (TAVI) treats elderly, high-risk aortic stenosis patients in a minimally invasive manner without opening the chest, with an operative mortality rate of less than 2%.
4.Rehabilitation
Rehabilitation therapy for cardiovascular diseases is often overlooked, but it is the key to reducing recurrence rates and improving quality of life. China has promoted the “five prescriptions for cardiac rehabilitation” (medication, exercise, nutrition, psychology and smoking cessation), which can reduce the 2-year mortality rate of patients with heart attack by 25%-30% through personalized exercise training (e.g. aerobic exercise, resistance training), nutritional guidance (low-salt, low-fat and high-quality proteins), psychological interventions (to alleviate anxiety and depression) and smoking cessation management. 30%. For example, 5-year follow-up data from the Cardiac Rehabilitation Center of Shanghai Ruijin Hospital showed that the re-hospitalization rate of patients with standardized rehabilitation was 40% lower than that of patients without rehabilitation.
Recommended Hospitals: Top Discipline Clusters Lead Technical Breakthroughs
China's top hospitals for cardiovascular and cerebrovascular treatment have formed a echelon pattern of “national team + regional centers + specialty characteristics”, and the following institutions are at the international leading level in technological innovation, clinical research and rescue and treatment of difficult and serious diseases:
1. National Center for Cardiovascular Diseases (Fu Wai Hospital, Chinese Academy of Medical Sciences)
As the “last stop for cardiovascular diseases in China”, Fu Wai Hospital has been ranked among the top three cardiovascular specialties in the world for many years in a row (by Newsweek). Its strengths cover the full spectrum of coronary heart disease, arrhythmia, congenital heart disease, heart failure, etc. In particular, it remains at the international forefront in the treatment of complex coronary heart disease (e.g., chronic total occlusive lesion CTO), structural heart disease (transcatheter valve intervention), and end-stage heart failure (ECMO support, cardiac transplantation). in 2022, the hospital will have completed more than 25,000 PCI surgeries, and the annual volume of cardiac transplantation will be more than 100 surgeries (No.1 in China).
2. Beijing Anzhen Hospital of Capital Medical University
Specialized in “large vessel surgery” and “cardiovascular intervention”, the hospital's annual volume of cardiac large vessel surgery exceeds 15,000 cases, and the mortality rate of aortic coarctation surgery is less than 3% (the international average is about 5%); the hospital is a leader in China in the fields of radiofrequency ablation of atrial fibrillation, left ear blockade (stroke prevention) and other cardiovascular surgery. In the field of radiofrequency ablation of atrial fibrillation and left heart ear blockade (stroke prevention), the number of surgeries exceeds 5,000 cases per year.
3. Zhongshan Hospital of Fudan University (Shanghai)
Relying on the Shanghai Institute of Cardiovascular Diseases, it has significant advantages in coronary heart disease intervention, arrhythmia treatment and cardiovascular imaging diagnosis (such as cardiac magnetic resonance). Its “Chest Pain Center” treats more than 2,000 cases of acute heart attack annually, with an average D2B time of 55 minutes; in the field of transcatheter aortic valve replacement (TAVI), more than 3,000 surgeries have been completed, with a technical success rate of 98%.
4.Wuhan Asian Heart Hospital (private specialty benchmark)
As the largest private tertiary cardiovascular hospital in China, it is on par with international standards in the interventional treatment of coronary heart disease, arrhythmia and coronary artery disease, with an annual volume of more than 8,000 PCI procedures and more than 5,000 radiofrequency ablations, and has taken the lead in carrying out “day surgery” (such as simple arrhythmia radiofrequency ablation and discharge within 24 hours), which reduces the burden of patients. Reducing the burden on patients.
Core Advantages of Cardiovascular and Cerebrovascular Treatment in China
The rapid development of cardiovascular and cerebrovascular treatment in China has benefited from the multiple driving forces of technological innovation, system optimization, and the combination of traditional Chinese and Western medicines, forming unique “Chinese characteristics”:
1. Technological innovation
In recent years, the breakthrough of domestic medical devices has completely changed the situation of relying on imported high-end consumables:
biodegradable stents (e.g., LOPE NeoVas), drug-eluting balloons (e.g., Sentry), interventional valves, etc. have passed the approval of the National Innovative Medical Devices, and their performances have reached the international advanced level, with the price of imported products at only 1/2 to 2/3.
The localization rate of high-end equipment such as intracavitary imaging technology (e.g., OCT) and three-dimensional calibration system has been continuously improved, which reduces medical costs and benefits more patients.
2. System Advantages
Through the policy of “hierarchical diagnosis and treatment” and “medical association”, China has constructed a whole chain system of “screening at grassroots level - emergency treatment at secondary hospitals - complex treatment at tertiary hospitals - community rehabilitation”. For example, county-level hospitals are generally capable of thrombolysis for acute heart attacks (the thrombolysis rate in 2022 will be three times higher than that in 2015), and grassroots doctors can connect to tertiary hospitals through remote consultation, realizing that “major illnesses can be treated without leaving the county”.
3. Combination of Chinese and Western medicine
Chinese medicine plays an irreplaceable role in the treatment of cardiovascular and cerebrovascular diseases:
Acute stage: Chinese medicine injections (e.g., Danhong injection, Xuesetong injection) can assist in improving microcirculation and reducing ischemia-reperfusion injury;
Recovery phase: Chinese medicine compound (e.g., Astragalus Ginseng Yiqi Drops, Compound Danshen Drops) can regulate blood lipids, improve myocardial metabolism, and reduce restenosis after stenting;
Chronic disease management: acupuncture, tuina and other therapies can relieve angina symptoms, improve anxiety and enhance patient compliance.
4. Medical insurance coverage
China has included cardiovascular and cerebrovascular diseases in the basic medical insurance catalog, and most interventions (e.g., PCI, radiofrequency ablation), surgeries (e.g., bypass grafting, valve replacement), and commonly used medications (e.g., antiplatelet agents, statins) are reimbursed by 50%-80%. Some regions are also piloting “payment by case” (e.g., packaged payment for PCI surgery for acute infarction) to avoid overmedication and further reduce patients' out-of-pocket expenses.
Conclusion
China's cardiovascular and cerebrovascular treatment, whether it is the international influence of top hospitals, the success rate of interventional procedures, or the advantages of combining Chinese and Western medicines, all signify that China has ranked among the first in the world in this field. In the future, with the implementation of new technologies such as gene therapy, artificial heart and intelligent diagnosis and treatment, the “China Solution” will bring more benefits to patients with cardiovascular and cerebrovascular diseases around the world.