This two-center retrospective cohort study will use de-identified electronic health records from June 1, 2021 through June 1, 2026 to compare patients with coronary heart disease-related chronic left ventricular dysfunction or chronic heart failure and Qi and Yin deficiency syndrome who initiated Yiqi Fumai lyophilized injection within 24 hours after a common time zero with eligible patients who did not initiate the drug within 24 hours. Treatment was determined during routine care and was not assigned by the researchers. The planned cohort includes 200 randomly sampled records, comprising 150 initiators and 50 non-initiators. The primary economic outcome is total direct medical cost during the index hospitalization, and the primary comparative-effectiveness outcome is heart-failure-related rehospitalization within 90 days after time zero. Baseline differences will be addressed primarily using propensity-score overlap weighting.
This standalone record covers only the retrospective real-world comparative cohort component of a broader integrated research program. Electronic health records with index dates from June 1, 2021 through June 1, 2026 will be obtained from the Jinan and Tianjin study centers. Follow-up information for the retrospective primary outcomes will be ascertained through September 1, 2026. Time zero is the first point at which all verifiable eligibility criteria are met and baseline variables can be reconstructed. The treatment strategies are initiation of Yiqi Fumai lyophilized injection within 24 hours after time zero and no initiation within 24 hours after time zero. Future cumulative treatment duration is not used to define baseline exposure. Patients are not excluded from the primary intention-to-treat analogue solely because treatment subsequently lasted less than 7 days, the 10-day course was not completed, treatment was discontinued, or treatment crossover occurred. Actual dose, duration, discontinuation, completion, and crossover are recorded for adherence descriptions and prespecified per-protocol, landmark, time-dependent, or marginal structural model sensitivity analyses. The fixed sample includes 200 patients: 150 initiators and 50 non-initiators, with each center contributing 75 initiators and 25 non-initiators. All eligible index hospitalizations will first be enumerated and deduplicated, retaining the first eligible index hospitalization for patients with multiple records. Four sampling strata will then be formed by study center and 24-hour treatment strategy. Simple random sampling without replacement will be performed within each stratum using a prespecified random seed. The screening flow, random seed, and reasons for non-inclusion will be retained. The two domain-specific primary outcomes are analyzed separately without a joint success criterion, hierarchy, or performance goal. The primary economic outcome is total direct medical cost from time zero through discharge from the index hospitalization or in-hospital death. The primary comparative-effectiveness outcome is the first heart-failure-related rehospitalization within 90 days after time zero and after discharge from the index hospitalization, with death treated as a competing risk. The primary causal estimand is the average treatment effect in the overlap population. Propensity-score overlap weighting will include prespecified baseline covariates measured at or before time zero. Balance, overlap, positivity, extreme weights, and effective sample size will be evaluated. IPTW, matching, outcome regression, time-dependent analyses, marginal structural models, and 72-hour and Day-7 landmark analyses will be used as appropriate in sensitivity analyses.
Study Type
OBSERVATIONAL
Enrollment
200
Exposure is defined by initiation of Yiqi Fumai lyophilized injection within 24 hours after time zero in routine care. The actual preparation, dose, diluent, infusion rate, treatment dates, cumulative dose, cumulative duration, discontinuation reason, completion of a 10-day course, and subsequent crossover will be abstracted when documented. The researchers did not assign treatment.
Guang'anmen Hospital Jinan Hospital, China Academy of Chinese Medical Sciences
Jinan, Shandong, China
The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin Municipality, China
Total Direct Medical Cost From Time Zero Through the End of the Index Hospitalization
Total direct medical cost incurred from time zero to discharge from the index hospitalization or in-hospital death, whichever occurs first, will be calculated from itemized medical records using quantity multiplied by unit price and standardized to 2026 Chinese yuan. Cost incurred from admission to time zero will be treated as a baseline covariate. Total cost for the complete index hospitalization will be evaluated in a sensitivity analysis. The estimated average is for registration planning and does not truncate observation; every index admission is followed to its actual endpoint.
Time frame: From time zero to discharge from the index hospitalization or in-hospital death, whichever occurs first; an estimated average of 12 days.
Incidence of First Heart-Failure-Related Rehospitalization Within 90 Days
The cumulative incidence of the first unplanned rehospitalization after index discharge for which heart failure is the primary diagnosis or there is clearly documented worsening of heart failure will be estimated through 90 days after time zero. Death before rehospitalization will be treated as a competing risk. Adjusted absolute risk, risk difference, relative effect, and 95% confidence intervals will be reported.
Time frame: From time zero through Day 90; qualifying rehospitalizations occur after discharge from the index hospitalization
Incidence of First Heart-Failure-Related Rehospitalization Within 30 Days
The cumulative incidence of the first unplanned heart-failure-related rehospitalization within 30 days after time zero will be estimated using the same event definition as the 90-day primary comparative-effectiveness outcome, with death treated as a competing risk.
Time frame: From discharge from the index hospitalization through Day 30 after time zero
Incidence of Heart-Failure-Related Rehospitalization or All-Cause Death Within 90 Days
The proportion of patients with either an unplanned heart-failure-related rehospitalization after index discharge or death from any cause within 90 days after time zero will be reported as a composite supportive outcome. Time to the first component will be used.
Time frame: From time zero through Day 90
Incidence of All-Cause Death Within 90 Days
The proportion of patients who died from any cause within 90 days after time zero will be reported. The date and source of death ascertainment will be recorded when available.
Time frame: From time zero through Day 90
Incidence of Cardiovascular Death Within 90 Days
The proportion of patients with death classified as cardiovascular in origin within 90 days after time zero will be reported according to the prespecified source hierarchy and adjudication rules.
Time frame: From time zero through Day 90
Length of the Index Hospitalization
Length of the index hospitalization will be calculated from recorded admission to discharge or in-hospital death, whichever occurs first, using elapsed hours divided by 24 when timestamps are available. Date-only records will be flagged and handled consistently under the statistical analysis plan. Death is an endpoint rather than a reason to exclude the stay. The complete admission-based measure is descriptive; resource comparisons restricted to the period after time zero are reported separately.
Time frame: From admission to discharge from the index hospitalization or in-hospital death, whichever occurs first; an estimated average of 12 days.
Proportion of Patients With ICU or CCU Use During the Index Hospitalization
The proportion of patients with any documented admission to an intensive care unit or coronary care unit during the index hospitalization will be reported.
Time frame: From admission to discharge from the index hospitalization or in-hospital death, whichever occurs first; an estimated average of 12 days.
Duration of ICU or CCU Care During the Index Hospitalization
Cumulative time in ICU or CCU during the complete index hospitalization will be calculated in days, summing documented episodes without double-counting overlapping intervals. The primary descriptive denominator is the full cohort; patients with verified no use contribute zero days, whereas unknown use contributes missing data. Results among actual users are reported separately. ICU/CCU time before and after time zero is distinguished. The estimated average of 12 days refers to the observation window, not to expected ICU/CCU duration.
Time frame: From admission to discharge from the index hospitalization or in-hospital death, whichever occurs first; an estimated average of 12 days.
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