Hospital Admissions for Heart Failure on the Rise

A comparison of 2 time periods shows that following an initial decline, hospital admissions for primary management of heart failure rose between 2014 and 2017, reports JAMA Cardiology.

This retrospective study investigated potential overall and sex-specific trends seen in primary and 30-day readmission visits for heart failure between 2010 and 2017. “Previous studies have described the secular trends of overall heart failure hospitalizations, but the literature describing the national trends of unique index hospitalizations and readmission visits for the primary management of heart failure is lacking,” the authors noted.

For a primary diagnosis of heart failure between January 1, 2010, and December 31, 2017, they extracted pertinent data from the Nationwide Readmissions Database (NRD) created by the Agency for Healthcare Research and Quality, grouping unique primary hospitalizations per patient per year. The mean patient age was 72.1 (95% CI, 72.0-72.3) years, and 48.9% (95% CI, 48.7%-49.0%) were women.

Heart failure was defined International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes.

There were 8,273,270 primary hospitalizations for heart failure during the study years for 5,092,626 patients, and 1,269,109 of the individuals had 2 or more heart failure hospitalizations. From 2010 to 2013, primary hospitalizations declined almost 7.0%, from 4.4 to 4.1, before rising once again almost 17.0% between 2014 and 2017, from 4.2 to 4.9 (all rates were calculated per 1000 US adults).

Postdischarge heart failure readmissions and all-cause 30-day readmissions followed similar patterns from 2010 to 2014 to 2017, but with less fluctuation:

• Heart failure: from 1.0 to 0.9 to 1.1, for an overall change of 10.0%
• All-cause: from 0.8 to 0.7 to 0.9, for an overall change of 12.5%

Additional analyses found:

• There were 35,197,725 hospitalizations between 2010 and 2017 with a primary or secondary heart failure diagnosis.
• An overall increase in hospitalizations for a primary or secondary diagnosis: from 18.0 in 2010 to 17.8 in 2014 to 21.0 in 2017.
• Most patients had Medicare coverage, which remained steady for the study’s duration, starting at 75.8% (95% CI, 74.9%-76.8%) in 2010 and ending at 75.6% (95% CI, 75.0-76.2%) in 2017.
• The most common comorbidities were hypertension, coronary artery disease (CAD), and renal disease.
• Five of the 6 comorbidities accounted for were occurring at higher rates by the end of the study compared with at the beginning, except for CAD:
  • Hypertension: 76.5% vs 91.4%
  • Diabetes: 44.9% to 48.9%
  • Lipid disorders: 40.4% to 53.1%
  • Chronic obstructive pulmonary disease: 29.7% to 35.4%
  • Renal disease: 45.9% to 60.6
  • CAD: 54.3% to 54.1%

Patients were also younger by the end of the study, with the mean (SD) age falling from 72.5 (13.4) to 71.6 (15.4) years, and the proportion of women dropped from 50.3% (95% CI, 49.7%-50.8%) to 47.9% (95% CI, 47.6%-48.1%).

“Our study provides descriptive analyses of national hospitalization utilization and does not risk adjust readmission risk,” the authors noted. “The increasing hospitalization rate in our study may represent an actual increase in [heart failure] hospitalizations or shifts in administrative coding practices, increased use of [heart failure] biomarkers, or lower thresholds for diagnosis of [heart failure] with preserved ejection fraction.”

Limits on the generalizability of the authors’ findings include unavailability of clinical data, because the NRD is an administrative database; lack of information on patient race and ethnicity; and not all hospitalizations and readmission being included in the NRD.

The authors recommended that future studies look into developing and more effectively individualizing strategies to better manage heart failure among women and men.

Reference

Agarwal MA, Fonarow GC, Ziaeian B. National trends in heart failure hospitalizations and readmissions from 2010 to 2017. JAMA Cardiol. Published online February 10, 2021. doi:10.1001/jamacardio.2020.7472