Abstract 20946: Decreasing Mortality and Hospital Costs: Trends in Congestive Heart Failure Exacerbation Admissions From 2004 to 2014

Abstract

Introduction: Congestive Heart Failure (CHF) exacerbations are associated with high mortality rates and exact significant costs on the health care system. New guidelines, innovations in technology and novel pharmacological agents for treatment of patients admitted with CHF have been developed in the last decade. While they have been shown to improve outcomes independently, data is limited on the cumulative effects of these interventions. We investigated the impacts of these therapeutic modalities over 10 years, and hypothesized improved outcomes of in-hospital admission for CHF exacerbation. Methods: This is a retrospective cohort study using the 2004-2014 National Inpatient Sample, the largest publicly available inpatient database in the United States. We included women and men >18 years of age admitted between 2004 and 2014 with a primary diagnosis of CHF (using ICD-9 CM codes). The primary outcome was all-cause in-hospital mortality and the secondary outcomes were mean total hospital cost and mean length of stay (LOS). STATA 13.0 was used for data analysis; costs were adjusted for inflation using the Bureau of Labor Statistics calculator. Results: 2,254,286 patients were included in this study. The mean age was 72.6 years, and 1,142,923 patients were female (50.7%). The inpatient mortality rate was 3.9% in 2004 and decreased with statistical significance to 2.9% in 2014 (p-trend <0.001) [Figure 1]. Mean hospital cost adjusted for inflation was $11605 in 2004 and decreased to $11,272 in 2014 [Figure 2]. Mean LOS decreased from 5.4 days in 2004 to 5.2 days in 2014. Conclusions: Over the course of 10 years, advances in care for patients with CHF have led to improvements in inpatient mortality rates, with marginally decreased hospital costs when inflation is taken into account. This likely reflects advances in comprehensive cardiovascular care, increasing use of evidence based guidelines, and introduction of novel medications and new therapeutic modalities.