Cardiology · Advanced heart failure · 2026
Heart failure treatment in China,
step by step, with the evidence.
When medication alone isn't enough, heart failure care moves through a set sequence of steps. First treat any reversible cause. Then optimise medicines for at least three months. Then add the right device: an ICD, CRT or CCM. An LVAD or heart transplant is reserved for the most advanced cases. This guide explains each step, who qualifies and what the major trials found.
Quick answer
What are the treatment options when heart failure medication isn't enough?
For heart failure with reduced ejection fraction, doctors first treat reversible causes (blocked arteries, valve disease, congenital defects) and optimise guideline medicines for at least 3 months. If the ejection fraction is still 35% or less, an ICD is considered to prevent sudden cardiac death. Patients with a wide QRS and left bundle branch block may benefit from CRT (biventricular pacing, CRT-P or CRT-D). Selected patients with a narrow QRS and an ejection fraction of 25–45% may be offered cardiac contractility modulation (CCM). If symptoms remain severe, a left ventricular assist device (LVAD) or heart transplant is evaluated.
23%
Lower death risk with ICD
EF ≤35%, NYHA II–III; ICD vs placebo, 2,521 patients
SCD-HeFT, NEJM 2005
20% vs 30%
Deaths with vs without CRT
NYHA III–IV with dyssynchrony, 813 patients, mean 29.4 months
CARE-HF, NEJM 2005
10.8% → 2.9%
CV death / HF hospitalisation
CCM vs medical therapy, narrow QRS, EF 25–45% (n=160)
FIX-HF-5C, JACC HF 2018
58.4%
5-year survival on HeartMate 3
vs 43.7% on the older axial-flow pump
MOMENTUM 3, JAMA 2022
941
Heart transplants in China, 2023
5,208 reported in 2015–2023
China Heart Transplant Registry
4 + 1
LVADs approved in China
Four Chinese-made pumps plus HeartMate 3 (2024)
See LVAD page
The pathway
Each step, and who it is for.
1 · Treat reversible causes
Coronary disease may need stenting or bypass; valve disease may need TAVR, TEER (edge-to-edge mitral repair) or valve surgery; congenital defects may need repair or closure. Fixing the cause can improve heart function.
Cardiac surgery / cath lab
2 · Guideline medical therapy ≥3 months
Medicines are optimised before most device decisions. Ejection fraction is then re-measured, because some hearts recover enough that no device is needed.
All patients
3a · ICD
Implantable cardioverter-defibrillator to stop life-threatening rhythms. Available as single-chamber, dual-chamber or extravascular (lead under the breastbone) systems.
Sudden-death prevention
3b · CRT-P / CRT-D
Biventricular pacing that re-synchronises the two ventricles. CRT-D adds a defibrillator. The strongest evidence is in left bundle branch block with a QRS of 150 ms or more.
Symptoms + survival
3c · CCM
Cardiac contractility modulation delivers non-pacing electrical signals to strengthen contraction. Studied in patients with an ejection fraction of 25–45% and NYHA class III symptoms who are not CRT candidates.
Symptoms + exercise
4 · LVAD → heart transplant
If symptoms stay severe despite all of the above, a mechanical heart pump (LVAD) can bridge to transplant or be used long term. Transplant remains the definitive treatment, but in China access for foreign nationals is restricted.
End-stage
At a glance
The heart failure treatment pathway
The diagram follows the sequence many Chinese heart failure centres use, which is consistent with the American and European guidelines. Two things happen in parallel with the main path. Any reversible cause is treated. And the ICD decision is made once the ejection fraction stays at or below 35% after optimised medication.
Who qualifies
Guideline criteria for each device
Device decisions rest on three measurements: ejection fraction (from echocardiography or MRI), QRS duration and pattern (from a 12-lead ECG) and symptom class (NYHA). Bring recent copies of all three. Without them, a cardiologist can't give a meaningful opinion.
| Device | Typical candidate | Guideline strength |
|---|---|---|
| ICD (primary prevention) | EF ≤35% with NYHA II–III symptoms despite optimised medication; ischaemic patients ≥40 days after a heart attack; expected survival > 1 year | AHA/ACC/HFSA 2022: class 1. ESC 2021: class I (ischaemic), IIa (non-ischaemic) |
| CRT (CRT-P or CRT-D) | EF ≤35%, sinus rhythm, LBBB with QRS ≥150 ms, symptoms despite medication | Class 1 / class I in both guidelines |
| CRT, intermediate QRS | LBBB with QRS 120–149 ms (US) or 130–149 ms (ESC); or non-LBBB with QRS ≥150 ms | Class 2a / IIa |
| CCM | NYHA III, EF 25–45%, not a CRT candidate (narrow QRS) | Approved device; studied in FIX-HF-5C |
| LVAD | Advanced (stage D) heart failure despite optimal therapy, as a bridge to transplant or long-term (destination) therapy | Specialist heart-failure team decision |
Simplified from the 2022 AHA/ACC/HFSA heart failure guideline and the 2021 ESC heart failure and pacing guidelines. Not a substitute for the full criteria.
For international patients
What can realistically be done in China
Most of this pathway can be delivered to visiting patients. Treating reversible causes (PCI, bypass, TAVR and valve surgery) and device implants (ICD, CRT, CCM) involve a planned admission, usually followed by a few days of checks and device programming before flying home. LVAD implantation needs a much longer stay and close long-term follow-up, so it suits patients who can arrange ongoing care.
Heart transplantation is different. Under Chinese regulations, organs are allocated through a national system with priority for Chinese citizens. Hospitals may not transplant foreign citizens who come as tourists, and transplants for foreign residents require health-authority review. We do not arrange transplant travel. See the heart transplant page for details.
A practical first step is a remote review. Send your echo report, ECG, medication list and any device interrogation reports, and a partner cardiologist will say which steps, if any, apply to you.
Published experience
Centres with published
advanced heart failure work.
Fuwai Hospital, National Center for Cardiovascular Diseases 阜外医院
Lead authors of the China Heart Transplant Registry report on 2,262 transplants in 2015–2019 (Chin Med J 2025)
Beijing Anzhen Hospital 北京安贞医院
Lead centre of the 7-centre CH-VAD (magnetically levitated LVAD) study, 77 patients (iScience 2025)
TEDA International Cardiovascular Hospital 泰达国际心血管病医院
Single-centre series of 36 HeartCon LVAD implants; 1- and 2-year survival 91% (J Thorac Dis 2025)
Zhongshan Hospital, Fudan University 复旦大学附属中山医院
Participating centre in the multicentre CH-VAD LVAD study (iScience 2025)
Shanghai Chest Hospital 上海市胸科医院
Participating centre in the multicentre CH-VAD LVAD study (iScience 2025)
Boao Super Hospital 博鳌超级医院
First Optimizer Smart CCM implant in China, October 2019 (manufacturer report)
FAQ
Heart failure treatment — answered.
- What is the treatment for heart failure when medication stops working?
- Doctors first check for reversible causes such as blocked arteries or valve disease, and make sure medicines have been optimised for at least 3 months. Device options follow. An ICD protects against sudden death if the ejection fraction is 35% or less. CRT helps patients with a wide QRS and left bundle branch block. CCM may suit selected patients with a narrow QRS and an ejection fraction of 25–45%. For end-stage disease, an LVAD or heart transplant is evaluated.
- Do I need an ICD if my ejection fraction is below 35%?
- Not automatically. Guidelines recommend re-measuring the ejection fraction after a period of optimised medication (and at least 40 days after a heart attack), because it often improves. If it stays at 35% or less with NYHA class II–III symptoms and you are expected to live more than a year, an ICD is recommended. In SCD-HeFT it lowered the risk of death by 23%. The benefit is clearest in heart failure caused by coronary disease. In the DANISH trial of non-ischaemic heart failure, overall survival was not significantly better, although sudden death was halved.
- What is the difference between CRT-P and CRT-D?
- Both pace the left and right ventricles to make them contract together. CRT-P is a pacemaker only; CRT-D also contains a defibrillator. In COMPANION, CRT-P reduced deaths by 24% (not statistically significant, P=0.059) and CRT-D by 36% (P=0.003) compared with medication alone. CRT-D is chosen when the patient also meets ICD criteria.
- What if my QRS is narrow — is there any device for me?
- CRT does not help patients with a narrow QRS, and the ESC guidelines advise against it below 130 ms. Cardiac contractility modulation (CCM) was designed for this group. In FIX-HF-5C (160 patients, QRS < 130 ms, EF 25–45%), it improved exercise capacity, quality of life and NYHA class. It is approved in China.
- Is an LVAD available in China?
- Yes. Four Chinese-made LVADs have been approved (EVAHEART, CH-VAD, HeartCon and Corheart 6), and Abbott's HeartMate 3 was approved in July 2024. Published Chinese series report around 91% one-year survival (CH-VAD, 77 patients; HeartCon, 36 patients). These are smaller studies than the international HeartMate 3 trial.
- Can a foreigner get a heart transplant in China?
- In general, no. A 2007 Ministry of Health notice prohibits transplants for foreign citizens who come to China as tourists. Transplants for foreign residents need provincial and national health-authority review, and Chinese citizens have priority. Organs are allocated through the national COTRS system. We do not arrange transplant travel, but we can help with evaluation, LVAD and other parts of the pathway.
- How long can you live with advanced heart failure on these treatments?
- It varies too much for a single number. For reference, 5-year survival with the HeartMate 3 LVAD was 58.4% in the MOMENTUM 3 trial. For adults transplanted in 2002–2009, the international registry reported a median survival of 12.5 years. Your own outlook depends on age, kidney and liver function and other conditions.
- How much does heart failure device treatment cost in China?
- Cost depends mainly on the device (an ICD, CRT-D, CCM and LVAD differ by an order of magnitude) and on the length of the hospital stay. Prices also change with China's national procurement for some devices. We don't publish a single price. After a cardiologist reviews your records, you receive an itemised written quote for the specific plan.
- How long do I need to stay in China?
- For an ICD, CRT or CCM implant, plan on the admission plus about a week for wound checks and device programming before flying. An LVAD needs a much longer stay, with training for you and a caregiver, and ongoing specialist follow-up. Your coordinator will confirm the timeline after the cardiologist's review.
Related guides
ICD for sudden-death prevention
Single-, dual-chamber and extravascular ICDs; who qualifies at EF ≤35%.
Read the guideCRT-P / CRT-D (biventricular pacing)
For wide QRS with left bundle branch block: trial data and criteria.
Read the guideCardiac contractility modulation (CCM)
A device option for narrow QRS, EF 25–45% — approved in China.
Read the guideLVAD (artificial heart pump)
HeartMate 3 and Chinese-made pumps: outcomes and approvals.
Read the guideHeart transplant in China
Outcomes, volumes — and the rules for foreign patients.
Read the guideCardiac surgery in China
Bypass, valve surgery, TAVR and other procedures that treat reversible causes.
Read the guideSources
References
- Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary. J Am Coll Cardiol. 2022;79(17):1757–1780.
- McDonagh TA, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–3726.
- Glikson M, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427–3520.
- Bardy GH, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure (SCD-HeFT). N Engl J Med. 2005;352(3):225–237.
- Køber L, et al. Defibrillator implantation in patients with nonischemic systolic heart failure (DANISH). N Engl J Med. 2016;375(13):1221–1230.
- Bristow MR, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure (COMPANION). N Engl J Med. 2004;350(21):2140–2150.
- Cleland JG, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure (CARE-HF). N Engl J Med. 2005;352(15):1539–1549.
- Abraham WT, et al. A randomized controlled trial to evaluate the safety and efficacy of cardiac contractility modulation (FIX-HF-5C). JACC Heart Fail. 2018;6(10):874–883.
- Mehra MR, et al. Five-year outcomes in patients with fully magnetically levitated vs axial-flow left ventricular assist devices in the MOMENTUM 3 randomized trial. JAMA. 2022;328(12):1233–1242.
- Lu Y, et al. Multicenter study for CH-VAD as a fully magnetically levitated left ventricular assist device. iScience. 2025;28(2):111764.
- Liu X, et al. Survival prognosis and clinical experience of HeartCon-type left ventricular assist device implantation for treating patients with end-stage heart failure: a single-center retrospective study from China. J Thorac Dis. 2025.
- Khush KK, et al. The International Thoracic Organ Transplant Registry of the ISHLT: Thirty-sixth adult heart transplantation report — 2019. J Heart Lung Transplant. 2019;38(10):1056–1066.
- 2024 annual report on cardiovascular health and diseases in China: data and trend (China Heart Transplant Registry figures, 2015–2023).
- Lin S, et al.; China Heart Transplant Registry Collaborative Group. Heart transplantation performance in China: five-year experience after transplantation system reform. Chin Med J (Engl). 2025;138(5):589–591.
- Ministry of Health General Office. 卫生部办公厅关于境外人员申请人体器官移植有关问题的通知 (卫办医发〔2007〕110号), 26 June 2007 — no transplants for foreign citizens visiting as tourists; foreign residents require provincial and national health-authority review; Chinese citizens have priority.
Send your echo and ECG
for an honest device review.
Share your latest echocardiogram, 12-lead ECG, medication list and any device reports. A partner cardiologist will tell you in writing where you are on the pathway and which options are realistic. If the answer is "optimise medication first", the review will say so.
This page is for general education only and is not medical advice. Device and surgical treatment for heart failure depends on your ejection fraction, ECG, symptoms, other conditions and how you respond to medication, and only your cardiologist can decide what fits. Trial results describe groups of patients, not what will happen to you. We are an independent patient-coordination service and are not affiliated with any device manufacturer.