Abstract 17241: National Trends in Systolic and Diastolic Heart Failure From 2004 to 2014

Abstract

Introduction: Heart Failure (HF) affects 6 million people in the US and costs $30.7B/year. Prior studies have shown declines in hospitalization rates, length of stay (LOS), and mortality for HF patients, but it is unclear if these trends hold true for both systolic HF (SHF) and diastolic HF (DHF). To better assess the epidemiological and economic burden of HF, we assessed the trends in LOS, mortality, and cost for both SHF and DHF. Methods: We identified hospitalizations for SHF (primary diagnosis ICD-9 codes 428.1, 428.2x, 428.4x or 428.9) and DHF (code 428.3x) from 2004 to 2014 in the National Inpatient Sample (NIS). National estimates were calculated using the NIS sampling weights. LOS, in-patient mortality, charges, demographics, and co-morbidities were abstracted. Results: We found an overall decreasing trend in LOS for HF, with LOS declining more sharply for DHF than for SHF hospitalizations (Cuzick test; Table 1 and Fig. 1). In 2014, LOS for DHF was on average 4.1 hours shorter than for SHF (95% confidence interval [CI] 3.5 - 4.6h). Inpatient mortality decreased despite an increase in number of co-morbidities for both groups, but in 2014 the odds of a patient dying with SHF were higher than for DHF (odds ratio 1.16, CI (1.14, 1.17). Total charges increased for SHF but remained relatively unchanged for DHF. In 2014, a hospitalization for SHF cost on average $10,349 more than for DHF (p<0.001). Conclusion: While DHF costs have remained relatively unchanged, SHF costs have risen between 2004 and 2014 despite an overall decrease in LOS and concurrent decline in inpatient mortality. This cost increase may have resulted, in part, from increased use of advanced support devices in these patients. Further studies will be needed to identify the reasons for increased cost of care such as use of percutaneous mechanical circulatory support devices.