Trends In Hospitalization For Heart Failure Research Articles

Abstract 18447: Comparative Seasonal Variation in Outcomes Among Patients Hospitalized for Heart Failure in Cold- and Warm-Climate States

Background: Despite emerging evidence that extreme heat and air pollution exposure are linked to adverse cardiovascular disease outcomes, paradoxical seasonal trends in heart failure hospitalizations and deaths have been observed, with peaks occurring in winter months. This study aimed to explore how seasonal variations in heart failure admissions differ among individuals hospitalized in cold-climate and warm-climate states. Methods: Population-level, state-wide data were used to explore outcomes among all individuals hospitalized for heart failure in Texas (1999-2016) and New York (1994-2007). Seasonal variation was assessed using time of discharge (January-March, April-June, July-September, October-December). Multivariable logistic and linear regression were used to explore the relationship between time of discharge and the primary outcomes of interest: mortality and length of stay (LOS). Analyses were adjusted for age, sex, race, ethnicity, and comorbidities (hypertension, hyperlipidemia, diabetes, CAD, arrhythmias, anemia, COPD, tobacco use). Results: Among individuals hospitalized for heart failure in both Texas and New York, mortality and LOS were significantly increased during winter months compared to spring, summer, and early fall (Table). While similar seasonal trends were observed across states, the observed effect sizes were smaller in the Texas population. Conclusions: Among patients hospitalized for heart failure in Texas and New York, there is an increase in mortality and LOS during winter months. However, the differences in effect sizes after controlling for traditional risk factors suggests that other variables (i.e., temperature fluctuations) may affect these seasonal trends and warrants further exploration.

Trends in HF Hospitalizations Among Young Adults in the United States From 2004 to 2018

ObjectivesThe aim of this study was to assess trends in heart failure (HF) hospitalizations among young adults. BackgroundData are limited regarding clinical characteristics and outcomes of young adults hospitalized for HF. MethodsThe National Inpatient Sample database was analyzed to identify adults aged 18 to 45 years who were hospitalized for HF between 2004 and 2018. ResultsIn total, 767,180 weighted hospitalizations for HF in young adults were identified, equivalent to 4.32 (95% CI: 4.31-4.33) per 10,000 person-years. Overall HF hospitalizations per 10,000 U.S. population of young adults decreased from 2.43 in 2004 to 1.82 in 2012, followed by an increase to 2.51 in 2018. Black adults (50.1%) had a significantly higher proportion of HF hospitalizations compared with White (31.9%) and Hispanic adults (12.2%) throughout the study period. Nearly half of patients (45.8%) lived in zip codes in the lowest quartile of national household income. Overall, in-hospital mortality was 1.3%, which decreased over time; this trend was consistent by sex and race. The overall mean LOS (5.2 days) remained stable over time, while the mean inflation-adjusted cost increased from $12,449 in 2004 to $16,786 in 2018, with significant overall differences by race and sex. ConclusionsThis longitudinal examination of U.S. clinical practice revealed that HF hospitalizations among young adults have increased since 2013. Approximately half of these patients are Black and reside in zip codes in the lowest quartile of national household income. Temporal trends showed decreased in-hospital mortality, stable adjusted lengths of stay, and increased inflation-adjusted costs, with significant racial differences in hospitalization rates.

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

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.

Trends in Heart Failure Hospitalizations in the US from 2008 to 2018

Heart failure (HF) is a major driver of health care costs in the United States and is increasing in prevalence. There is a paucity of contemporary data examining trends among hospitalizations for HF that specifically compare HF with reduced or preserved ejection fraction (HFrEF or HFpEF, respectively). Using the National Inpatient Sample, we identified 11,692,995 hospitalizations due to HF. Hospitalizations increased from 1,060,540 in 2008 to 1,270,360 in 2018. Over time, the median age of patients hospitalized because of HF decreased from 76.0 to 73.0 years (P < 0.001). There were increases in the proportions of Black patients (18.4% in 2008 to 21.2% in 2018) and of Hispanic patients (7.1% in 2008 to 9.0% in 2018; P < 0.001, all). Over the study period, we saw an increase in comorbid diabetes, sleep apnea and obesity (P < 0.001, all) in the entire cohort with HF as well as in the HFrEF and HFpEF subgroups. Persons admitted because of HFpEF were more likely to be white and older compared to admissions because of HFrEF and also had lower costs. Inpatient mortality decreased from 2008 to 2018 for overall HF (3.3% to 2.6%) and HFpEF (2.4% to 2.1%; P < 0.001, all) but was stable for HFrEF (2.8%, both years). Hospital costs, adjusted for inflation, decreased in all 3 groups across the study period, whereas length of stay was relatively stable over time for all groups. The volume of patients hospitalized due to HF has increased over time and across subgroups of ejection fraction. The demographics of HF, HFrEF and HFpEF have become more diverse over time, and hospital inpatient costs have decreased, regardless of HF type. Inpatient mortality rates improved for overall HF and HFpEF admissions but remained stable for HFrEF admissions.

Heart failure hospitalization trends during a very long-term follow-up up to 18 years

Abstract Background Heart Failure (HF) is the first cause of hospitalizations in people older than 65 years. Often patients suffer recurrent hospital admissions. Objective To assess recurrent HF-related hospitalizations during very long-term follow-up in a cohort of HF outpatients managed in an ambulatory structured HF Unit. Methods End of follow-up was 31.8.2019 (at least 1-year follow-up for alive patients, up to 18 years). Heart failure hospitalizations were defined as unplanned hospitalizations of at least 24 hours due to worsening heart failure and were identified from clinic records, hospital wards, or electronic Catalan history record. Death was recorded from the same sources and Spanish Health System and Spanish Death Registry. Lost information during follow-up was adequately censored (1 patient for survival status and 37 for HF-related hospitalizations). Results A total of 2355 patients were included. Follow-up span a total of 12,472 patients-years. 1682 HF-related hospitalizations were recorded in 725 patients (13.5 per 100 patients-years). Number of admissions ranged from 0 in 1630 patients to 22 in 1 patient (patients with hospitalizations, median 2 [Q1-Q3, 1–3]; 118 patients had 4 or more hospitalizations). HF hospitalization density incidence was higher during the 10 first years in patients with HF hospitalizations in the precedent year before HF Clinic baseline visit (table). By contrast, if only patients who died during follow-up were considered (N=1299), hospitalization trends significantly increased in their last period of life: 11.7%, 8.9%, 13.6%, 20.8% and 44.9% from the first to the last period (quintile) of their trajectory, respectively. Conclusions HF hospitalizations occur during the whole HF trajectory, with an increasing trend at the end of the every patient trajectory. Funding Acknowledgement Type of funding source: None

Heart Failure Hospitalization Trends During the Early Phase of the COVID 19 Pandemic

PurposeTo quantify the change in heart failure (HF) hospitalizations observed in the early phase of the COVID-19 pandemic across a large, multi-center health care system.MethodsMHealth Fairview encompasses four hospitals (one academic, three community-based) in the Minneapolis, Minnesota metro area. To compare HF hospitalization trends, two inpatient samples were created using HF discharges in the following time periods: pre COVID-19 (February 28, 2019-February 28, 2020) and post COVID-19 (April 1, 2020- May 15, 2020). March 2020 was excluded as this represented a transition point of the pandemic in the United States. Average number of discharges per day as well as demographics, diagnosis related group (DRG) codes, and inpatient mortality was then compared between the two inpatient HF samples.ResultsThe pre COVID-19 group had 2,601 patients with an average of 7.1 (+/-3) discharges per day. The post COVID-19 group had 210 patients with an average of 4.7 (+/-1.7) discharges per day, which represented a 34% reduction in HF discharges (p <0.001). No statistically significant differences were observed between the pre and post COVID-19 inpatient samples with respect to age (76 vs. 75 years, p = 0.25), gender (46% vs. 48% male, p = 0.7), and DRG codes (DRG 291: 78% vs. 85% p = 0.15). Inpatient HF mortality pre and post COVID-19 was not significantly different (3% vs. 2.9%, p = 0.99).ConclusionHF hospitalizations have decreased significantly during the early phase of the COVID-19 pandemic in this multi-center health care system, however the make-up of hospitalized patients remains similar. There is an urgent need to provide continued access to safe hospital care during the pandemic and to inform HF patients that inpatient care remains available.

Heart failure hospitalizations in persons with and without diabetes in an Italian region: 2008-2018

Abstract Background Hospitalization rate for heart failure (HF) is considered a prevention quality indicator and it is used as a tool to evaluate health services quality. This study aims to assess time trends in HF hospitalizations in a region of Southern Italy, focusing on diabetes mellitus as comorbidity. Methods Data were collected from hospital discharge records. All patients aged 18 or over hospitalized for HF in Abruzzo between 2008 and 2018 were selected, either with or without a diagnostic code of diabetes. Admissions for cardiac procedures were excluded. For each year, gender- and age-adjusted standardized hospitalization rates were calculated. Predictors of HF admissions were estimated by a multivariable regression model. Results Over the study period, 60,737 HF admissions occurred, 34,518 of which among people aged more than 65 (56.8%). A total of 15,424 hospitalizations were performed among diabetic patients (25.4%). The overall age- and gender-adjusted HF hospitalization rate declined substantially from 2008 to 2018 (-12.1%). Diabetes (adjOR 2.48; 95%CI 2.41-2.55), myocardial infarction (adjOR 3.92; 95%CI 3.70-4.14), peripheral vascular disease (adjOR 2.30; 95%CI 2.16-2.44), chronic obstructive pulmonary disease (adjOR 3.97; 95%CI 3.86-4.09) and renal disease (adjOR 5.61; 95%CI 5.44-5.78) were factors associated to an increased risk of HF hospitalization. Although HF admission rates remained higher, a significant reduction was highlighted among diabetic patients (-34.7%). Instead, time trend was nearly stable among persons without diabetes (+2.7%). Conclusions This study has shown a decline in HF hospitalization rate over the period considered, particularly among diabetic patients. HF hospitalization may be potentially avoided with good outpatient care. As the causes for HF admissions may include poor quality of care or problems accessing care, it is worthwhile to identify the triggering factors and the potential targets for an early intervention. Key messages A reduction of HF admissions was observed only among diabetics and not among people without diabetes. As the HF hospitalizations are potentially preventable, the knowledge of the epidemiology is crucial for management of preventive health care.

Trends in heart failure hospitalizations, patient characteristics, in-hospital and 1-year mortality: A population study, from 2000 to 2012 in Lombardy

BackgroundThis study was undertaken to evaluate trends in heat failure hospitalizations (HFHs) and 1-year mortality of HFH in Lombardy, the largest Italian region, from 2000 to 2012. MethodsHospital discharge forms with HF-related ICD-9 CM codes collected from 2000 to 2012 by the regional healthcare service (n=699797 in 370538 adult patients), were analyzed with respect to in-hospital and 1-year mortality; Group (G) 1 included most acute HF episodes with primary cardiac diagnosis (70%); G2 included cardiomyopathies without acute HF codes (17%); and G3 included non-cardiac conditions with HF as secondary diagnosis (13%). Patients experiencing their first HFH since 2005 were analyzed as incident cases (n=216782). ResultsAnnual HFHs number (mean 53830) and in-hospital mortality (9.4%) did not change over the years, the latter being associated with increasing age (p<0.0001) and diagnosis Group (G1 9.1%, G2 5.6%, G3 15.9%, p<0.0001). Incidence of new cases decreased over the years (3.62 [CI 3.58–3.67] in 2005 to 3.13 [CI 3.09–3.17] in 2012, per 1000 adult inhabitants/year, p<0.0001), with an increasing proportion of patients aged ≥85y (22.3% to 31.4%, p<0.0001). Mortality lowered over time in <75y incident cases, both in-hospital (5.15% to 4.36%, p<0.0001) and at 1-year (14.8% to 12.9%, p=0.0006). ConclusionsThe overall burden and mortality of HFH appear stable for more than a decade. However, from 2005 to 2012, there was a reduction of new, incident cases, with increasing age at first hospitalization. Meanwhile, both in-hospital and 1-year mortality decreased in patients aged <75y, possibly due to improved prevention and treatment.

Trends in hospitalization for congestive heart failure, 1996-2009.

Although heart failure (HF) is a common cause of hospital admissions, few data describe temporal trends in HF hospitalization. We present data on number of HF admissions, length of stay (LOS), and inpatient mortality in the United States, 1996-2009. To assess HF hospitalizations in a national sample of United States population. Data were obtained from the National Hospital Discharge Survey (NHDS), a national probability sample survey of discharges conducted annually by the National Center for Health Statistics. Sampling weights are applied to raw NHDS data to produce national estimates. Hospitalizations with a primary diagnosis of HF were identified using ICD-9-CM codes. We excluded hospitalizations where HF was a secondary diagnosis. Weighted least squares regression was used to test for linear trends in HF hospitalizations. Approximately 15.5 million weighted primary HF hospitalizations were included. The number of total primary HF hospitalizations increased from 1 000 766 in 1996 to about 1 173 832 in 2009 (β = 7371 hospitalizations per year; 95% confidence interval (CI): 552 to 14 190, P = 0.036). Mean LOS per hospitalization decreased from 6.07 days in 1996 to about 5.26 days in 2009 (β = -0.059 days per year; 95% CI: -0.079 to -0.039, P < 0.001). Inpatient mortality rates declined from 4.92% in 1996 to 3.41% in 2009 (β = -0.17% per year; 95% CI: -0.23 to -0.10, P < 0.001). In a nationally representative sample of HF hospitalizations, mean LOS and inpatient mortality rates declined over the past 2 decades. HF management cost is most likely to be reduced by decreasing the number of HF admissions.

August 2016 at a glance: the new ESC guidelines, and pathophysiology, epidemiology and prognosis of heart failure.

This issue has our new ESC guidelines for the diagnosis and treatment of heart failure (HF).1 Compared with the previous 2012 guidelines, major changes regard the introduction of the new category of patients with mid-range left ventricular ejection fraction (EF), a new algorithm for the diagnosis of HF, the inclusion of new exams for patients' evaluation, recommendations to prevent or delay the development of overt HF, including antidiabetic treatment with empaglifozin, a new algorithm for HF treatment, with the replacement of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers with an angiotensin receptor neprilysin inhibitor in the patients still symptomatic with a low EF, updated indications to cardiac resynchronization therapy, new evidence regarding treatment of comorbidities and more detailed indications for mechanical circulatory support.1 Treatment of HF with preserved EF (HFpEF) and treatment of acute HF are updated and summarized with new algorithms but, unfortunately, no major change is present, as no new drugs have reached evidence for treatment in these conditions.2, 3 A last paragraph with our gaps in evidence and a table with the messages about what to do or not to do in HF nicely summarize both future developments and current evidence.1 The use of cardiac implantable electronic devices to monitor and predict episodes of decompensation in HF patients is reviewed by Hawkins et al.4 Interestingly, a new strategy, moving from crisis detection to health maintenance, aimed at maintaining the “ideal state” and treating any deviation from homeostasis is proposed.4 A new rat model of HF, based on subtotal nephrectomy with development of stable chronic kidney disease and HFpEF, is described by Primessnig et al.5 Abnormalities in diastolic function were attended by a progressive upregulation of Na+/Ca2+ exchanger protein expression with a concomitant reduced Ca2+ extrusion capacity, with an increased activity in the reverse mode, e.g. Ca2+ import. Consistently, the administration of a Na+/Ca2+ inhibitor improved diastolic function acutely and cardiac function and remodelling in the long-term with new perspectives for HFpEF treatment.5 Marques et al. have measured microRNAs in arterial and coronary sinus venous samples in healthy volunteers and HF patients.6 Upregulation or downregulation of different microRNAs and cardiac release of micro-RNAs was found in the failing hearts, compared with controls, confirming the potential role of microRNAs as biomarkers and/or targets of treatment.6-10 Christ et al. have examined trends in HF hospitalizations in Germany.11 From 2000 to 2013, the absolute number of HF hospitalizations and of HF-related in-hospital days has continued to increase and this increase has been more pronounced in the older subjects. HF has remained the leading cause of hospitalizations and of in-hospital deaths in Germany. These data contrast with other recent studies from different countries showing a stable or decreasing proportion of HF hospitalizations.12, 13 Aging of the population, changes in the diagnostic procedures, outpatient care, and in the coding and reimbursement systems may all have influenced these results. Similar to previous data in patients with HF and reduced EF,14 QRS duration and morphology, namely left bundle branch block, are shown to have an independent prognostic value also in the patients with HFpEF enrolled in the I-PRESERVE clinical trial.15 The prognostic significance of the electrocardiographic abnormalities is shown also in the patients hospitalized for acute HF by another study.16 An article regarding patients hospitalized for acute HF shows the strong and independent relation between an increased length of hospital stay and post-discharge mortality at 90 days. Length of hospitalization was not predicted by baseline variables related to HF severity but was strongly associated with the occurrence of in-hospital worsening HF.17 The independent prognostic role of functional mitral regurgitation in patients with acute HF and either reduced or preserved EF, and in patients undergoing cardiac resynchronization therapy, respectively, is shown in two other studies.18, 19

Effectiveness of a multidimensional home nurse led heart failure disease management program—A French nationwide time-series comparison

The purpose of this study was to assess the effectiveness of a disease management program (DMP) in heart failure (HF) on the incidence of HF hospitalizations and related costs in a real-world population-based setting. Insuffisance CArdiaque en LORraine (ICALOR), a DMP for HF was established in 2006 in the French region of Lorraine. Patients were enrolled after an index HF hospitalization. They received educational and home-visit monitoring programs by HF-trained nurses. General physicians received automatic alerts about patients' significant clinical or biological changes. We used the ICALOR and the national diagnostic related group databases to conduct a comparison of time-series trends in HF hospitalizations in France. The economic impact was obtained using the national scale of costs in France. The median age of the 1222 patients recruited before 2010 was 76 years, and 65% were male. Upon enrollment, patients essentially presented with NYHA class II (n=537, 48%) or class III (n=359, 32%) symptoms. One-year mortality rate was 20.3%. The implementation of the ICALOR program was associated with a reduction in HF hospitalizations in Lorraine estimated by an absolute difference between the number of hospitalizations observed in the Lorraine region and that expected had it been similar to that observed in the whole country of -7.19% in 2010. The estimated annual hospital cost saved by ICALOR was €1,927,648 in 2010. Coordinated DMP of HF might improve outcome cost-effectively when implemented in a real-world population setting, and was associated in Lorraine with a substantial modification of the trend of HF hospitalizations.

Heart Failure–Associated Hospitalizations in the United States

This study sought to characterize temporal trends in hospitalizations with heart failure as a primary or secondary diagnosis. Heart failure patients are frequently admitted for both heart failure and other causes. Using the Nationwide Inpatient Sample (NIS), we evaluated trends in heart failure hospitalizations between 2001 and 2009. Hospitalizations were categorized as either primary or secondary heart failure hospitalizations based on the location of heart failure in the discharge diagnosis. National estimates were calculated using the sampling weights of the NIS. Age- and sex-standardized hospitalization rates were determined by dividing the number of hospitalizations by the U.S. population in a given year and using direct standardization. The number of primary heart failure hospitalizations in the United States decreased from 1,137,944 in 2001 to 1,086,685 in 2009, whereas secondary heart failure hospitalizations increased from 2,753,793 to 3,158,179 over the same period. Age- and sex-adjusted rates of primary heart failure hospitalizations decreased steadily from 2001 to 2009, from 566 to 468 per 100,000 people. Rates of secondary heart failure hospitalizations initially increased from 1,370 to 1,476 per 100,000 people from 2001 to 2006, then decreased to 1,359 per 100,000 people in 2009. Common primary diagnoses for secondary heart failure hospitalizations included pulmonary disease, renal failure, and infections. Although primary heart failure hospitalizations declined, rates of hospitalizations with a secondary diagnosis of heart failure were stable in the past decade. Strategies to reduce the high burden of hospitalizations of heart failure patients should include consideration of both cardiac disease and noncardiac conditions.

Improvement in U.S. Heart Failure Outcomes, 1998–2008

The past decade has witnessed improved prevention, recognition, and treatment of ischemic heart disease, an important cause of heart failure (HF). However, the U.S. population is aging, which might increase HF prevalence. These investigators assessed trends in hospitalization for HF and associated mortality between 1998 and 2008 in the U.S. Medicare fee-for-service population. Over 10 years, hospitalizations for …

Trends in Heart Failure Hospitalisation from One Area Health Service

Trends in Heart Failure Hospitalisation from One Area Health Service

The expanding national burden of heart failure in the United States: the influence of heart failure in women

Abstract Background Although some studies have shown that hospital admissions for heart failure doubled between 1973 and 1995, other data suggest that the heart failure hospitalization epidemic has stabilized in the United States. We sought to describe trends in heart failure hospitalizations over the past decade using data from the National Hospital Discharge Survey (NHDS). Methods The NHDS provides annual estimates of hospitalization discharges from a sample of hospitals in the United States. We combined the heart failure hospitalization frequencies with census estimates to calculate age and gender-specific annual hospitalization rates. Results Hospitalizations with a primary diagnosis of heart failure among adults (age ≥35) increased from 810,624 in 1990 to 989,500 in 1995 (annual increase 36,088, R2 = 0.816, P = .014), and to 1,088,349 in 1999 (annual increase 31,091, R2 = 0.780, P = .047). The age-adjusted hospitalization rate (per 1000 persons) increased from 7.186 in 1990 to 8.554 in 1999 for women (annual increase 0.14/year, R2 = 0.731, P = .002) and from 6.892 in 1990 to 7.372 in 1999 for men (annual increase 0.011/year, R2 = 0.008, P = 0.80). For women, the annual hospitalization rate increased from 1990 to 1999 in each age group (35–64, 65–74, 75–84, and ≥85), while the age-specific rates did not change in men. Conclusions Heart failure hospitalizations have continued to increase from 1990 to 1999. Although aging and growth of the US population contribute to this trend, the increases are substantially influenced by changes in hospitalization rates in women.

The expanding national burden of heart failure in the United States: the influence of heart failure in women

BackgroundAlthough some studies have shown that hospital admissions for heart failure doubled between 1973 and 1995, other data suggest that the heart failure hospitalization epidemic has stabilized in the United States. We sought to describe trends in heart failure hospitalizations over the past decade using data from the National Hospital Discharge Survey (NHDS). MethodsThe NHDS provides annual estimates of hospitalization discharges from a sample of hospitals in the United States. We combined the heart failure hospitalization frequencies with census estimates to calculate age and gender-specific annual hospitalization rates. ResultsHospitalizations with a primary diagnosis of heart failure among adults (age ≥35) increased from 810,624 in 1990 to 989,500 in 1995 (annual increase 36,088, R2 = 0.816, P = .014), and to 1,088,349 in 1999 (annual increase 31,091, R2 = 0.780, P = .047). The age-adjusted hospitalization rate (per 1000 persons) increased from 7.186 in 1990 to 8.554 in 1999 for women (annual increase 0.14/year, R2 = 0.731, P = .002) and from 6.892 in 1990 to 7.372 in 1999 for men (annual increase 0.011/year, R2 = 0.008, P = 0.80). For women, the annual hospitalization rate increased from 1990 to 1999 in each age group (35–64, 65–74, 75–84, and ≥85), while the age-specific rates did not change in men. ConclusionsHeart failure hospitalizations have continued to increase from 1990 to 1999. Although aging and growth of the US population contribute to this trend, the increases are substantially influenced by changes in hospitalization rates in women.