Trends of Heart Failure Hospitalization in the US Between 2004 and 2018

Doctor writing on clipboard
Doctor writing on clipboard
Researchers sought to determine characteristics and trends related to heart failure hospitalization and mortality in the US.

In the United States (US), hospitalizations for heart failure (HF) have been increasing since 2013, but inpatient mortality has been decreasing, according to research published in ESC Heart Failure.

For the study, researchers sourced data from the National Inpatient Sample (NIS). Age-adjusted trends of HF hospitalization and in-hospital mortality between 2004 and 2018 in the US were assessed.

Between 2004 and 2013, hospitalizations for HF decreased from 5.26 to 3.96 hospitalizations per 1000 US adults (annual percentage change [APC], -3.4; 95% CI, -3.8 to -2.9). By 2018, the rate had increased to 4.9 hospitalizations per 1000 US adults (APC, 4.7; 95% CI, 3.6 to 6.0).

The length of hospital stay decreased from 5.5 days in 2004 to 5.3 days in 2006 (P =.02) and 5.1 days in 2011 (P =.02). By 2018, the length of stay had increased to 5.4 days (P =.01).

In-hospital mortality between 2004 and 2007 decreased from 4.0% to 3.2% (APC, -5.9; 95% CI, -8.5 to -3.2). The reduction of in-hospital mortality declined more rapidly to a rate of 2.6% by 2018 (APC, -1.9; 95% CI, -2.3 to -1.5).

The average age of a patient hospitalized with HF was 72.3 years and 50% of hospitalizations occurred among women. The patient population was White (67.2%), Black (20.2%), and Hispanic (8.0%). Hospitalizations occurred primarily in urban hospitals (85.8%).

Stratified by ethnicity, the rate of in-hospital mortality declined by -6.2 (95% CI, -8.8 to -3.5) between 2004 and 2007 and -1.8 (95% CI, -2.1 to -1.4) between 2007 and 2018 among White patients. For Black patients, the decline was -5.8 (95% CI, -7.2 to -4.3) between 2004 and 2009 and -0.8 (95% CI, -1.4 to -0.2) between 2009 and 2018. The trend among the Hispanic population was a decrease of -5.9 (95% CI, -8.7 to -2.9) between 2004 and 2010, after which time there was a nonsignificant increase between 2010 and 2013 (APC, 4.4; 95% CI, -12.9 to 25.2) and nonsignificant decrease between 2013 and 2018 (APC, -3.3; 95% CI, -7.1 to 0.7).

This study may have been biased by not removing patients with repeated hospital admissions.

”In summary, hospitalizations for HF have been increasing since 2014 among both sexes and age groups,” the investigators stated. Despite the increase in hospitalizations, in-hospital deaths have been decreasing.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Salah HM, Minhas AMK, Khan MS, et al. Trends and characteristics of hospitalizations for heart failure in the United States from 2004 to 2018. ESC Heart Fail. Published online January 30, 2022. doi:10.1002/ehf2.13823