National Trends in Heart Failure Hospital Stay Rates, 2001 to 2009

Objectives This study sought to analyze recent trends over time in heart failure (HF) hospital stay rates, length of stay (LOS), and in-hospital mortality by age groups with a large national dataset of U. S. hospital discharges. Background Heart failure hospital stay rates, LOS, and mortality have fallen over the past decade for older Medicare beneficiaries, but whether this holds true for younger adults is unknown. Methods From the National Inpatient Sample, we calculated HF hospital stay rates, LOS, and in-hospital mortality from 2001 to 2009 with survey data analysis techniques. Results Hospital stays (n = 1,686,089) with a primary discharge diagnosis of HF were identified from National Inpatient Sample data between 2001 and 2009. The overall national hospital stay rate decreased from 633 to 463 hospital stays/100,000 persons, (-26.9%, p-for-trend <0.001). However, statistically significant declines (p < 0.001) were only observed for patients 55 to 64 years of age (-36.5%) 65 to 74 years (-37.4%), and >= 75 years (-28.3%) but not for patients 18 to 44 years of age (-12.8%, p = 0.57) or 45 to 55 years (-16.2%, p = 0.04). Statistically significant declines in LOS were only observed for patients 65 years of age and older. Overall in-hospital mortality fell from 4.5% to 3.3%, a relative decline of -27.4%, (p-for-trend <0.001), but patients 18 to 44 years of age did not exhibit a significant decline (-8.1%, p-for-trend = 0.18). In secondary analyses significant declines in HF hospital stay rate over time were observed for white men, white women, and black women but not for black men (-9.5%, p-for-trend = 0.43). Conclusions Younger patients have not experienced comparable declines in HF hospital stay, LOS, and in-hospital mortality as older patients. Black men remain a vulnerable population for HF hospital stay. (J Am Coll Cardiol 2013;61:1078-88) (C) 2013 by the American College of Cardiology Foundation