U.S. hospitalizations for heart failure have declined, study finds

Hospitalizations for heart failure in the U.S. declined considerably from 1998 to 2008, according to a new study.

Researchers analyzed data from all Medicare beneficiaries in the U.S. and Puerto Rico hospitalized at acute care hospitals from 1998 and 2008 with heart failure as a principal discharge diagnosis code. The goal of the study was to detect changes in rates of heart failure hospitalization and one-year mortality rates in the U.S. as a whole and by state or territory. Main outcome measures were changes in demographic characteristics and comorbid conditions as well as rates of hospitalization and one-year mortality. The study results appeared in the Oct. 19 Journal of the American Medical Association.

Overall, data from 55,097,390 Medicare beneficiaries were analyzed. After adjusting for age, sex and race, the authors found that the heart failure hospitalization rate decreased from 2,845 per 100,000 person-years in 1998 to 2,007 per 100,000 person-years in 2008 (P<0.001; relative decline, 29.5%). Heart failure hospitalization rates adjusted for age decreased during the study period among all categories of race and sex. For all race-sex categories, rate of decline was lowest among black men (4,142 to 3,201 per 100,000 person-years), even after adjustment for age (incidence rate ratio, 0.81; 95% CI, 0.79 to 0.84). One-year mortality rates adjusted for risk decreased from 31.7% to 29.6% from 1999 to 2008 (P<0.001; relative decline, 6.6%).

The authors noted that they only examined Medicare beneficiaries, that they could not determine whether changes in medical coding had affected their findings, and that they could not investigate differences in subtypes of heart failure, among other limitations. However, they concluded that overall risk-adjusted heart failure hospitalizations in the U.S. declined significantly from 1998 to 2008, primarily because fewer patients were being hospitalized (as opposed to a reduction in the frequency of hospitalizations), and that the rate of decline was lowest among black men.

The authors of an accompanying editorial applauded the study as the first to document improved heart failure hospitalization rates in the U.S. but noted that the event rate after discharge for a heart failure hospitalization “remains unacceptably high and requires immediate attention.” The editorialists suggested exploring the following strategies for improvement:

• Systematically assess and correct cardiac abnormalities;
• Treat noncardiac comorbid conditions, such as hypertension, renal dysfunction and diabetes;
• Increase use of underused therapies known to improve hospitalization rates, such as digoxin and eplerenone; and
• Schedule postdischarge visits promptly, especially in high-risk patients.