Trends In US Heart Failure Hospitalizations: Increased Volume And Patient Diversity With Decreased Total Costs, 2008-2018

Abstract

Introduction Heart failure (HF) is a major driver of US healthcare costs and prevalence is increasing. There is a paucity of contemporary data examining trends in HF hospitalizations, comparing HF with reduced and preserved ejection fraction (HFrEF and HFpEF, respectively). Methods and Results We identified 11,692,995 hospitalizations for HF from the National Inpatient Sample from 2008 to 2018. Over time, hospitalizations increased from 1,060,540 in 2008 to 1,270,360 in 2018. Over the study period, there were increases in the HFrEF and HFpEF diagnosis codes and a concomitant decrease in the unspecified HF diagnosis code. The median age of patients decreased from 76 to 73 years (p<0.001, all). The proportions of Black (18.4% in 2008 to 21.2% in 2018) and Hispanic patients (7.1% in 2008 to 9.0% in 2018, p<0.001, all) increased. Over time, we saw an increase in comorbid diabetes, coronary artery disease, peripheral arterial disease, chronic obstructive pulmonary disease, sleep apnea, and obesity (p<0.001, all) in the entire HF cohort and both subgroups. Admissions for HFpEF were more likely to be white and older compared to HFrEF admissions and had lower costs. Inpatient mortality decreased for overall HF (3.3% to 2.6%) and HFpEF (2.4% to 2.1%, p<0.001, all), but was stable for HFrEF at 2.8%. Hospital costs decreased among all 3 groups over time, while length of stay was stable. Conclusions HF hospitalization volume increased over time and across subgroups. The demographics of all cohorts were more diverse, and hospital costs have decreased. Inpatient mortality improved for overall HF and HFpEF admissions but did not improve for HFrEF. Heart failure (HF) is a major driver of US healthcare costs and prevalence is increasing. There is a paucity of contemporary data examining trends in HF hospitalizations, comparing HF with reduced and preserved ejection fraction (HFrEF and HFpEF, respectively). We identified 11,692,995 hospitalizations for HF from the National Inpatient Sample from 2008 to 2018. Over time, hospitalizations increased from 1,060,540 in 2008 to 1,270,360 in 2018. Over the study period, there were increases in the HFrEF and HFpEF diagnosis codes and a concomitant decrease in the unspecified HF diagnosis code. The median age of patients decreased from 76 to 73 years (p<0.001, all). The proportions of Black (18.4% in 2008 to 21.2% in 2018) and Hispanic patients (7.1% in 2008 to 9.0% in 2018, p<0.001, all) increased. Over time, we saw an increase in comorbid diabetes, coronary artery disease, peripheral arterial disease, chronic obstructive pulmonary disease, sleep apnea, and obesity (p<0.001, all) in the entire HF cohort and both subgroups. Admissions for HFpEF were more likely to be white and older compared to HFrEF admissions and had lower costs. Inpatient mortality decreased for overall HF (3.3% to 2.6%) and HFpEF (2.4% to 2.1%, p<0.001, all), but was stable for HFrEF at 2.8%. Hospital costs decreased among all 3 groups over time, while length of stay was stable. HF hospitalization volume increased over time and across subgroups. The demographics of all cohorts were more diverse, and hospital costs have decreased. Inpatient mortality improved for overall HF and HFpEF admissions but did not improve for HFrEF.