Trends in Hospital Admissions for Systolic and Diastolic Heart Failure in the United States Between 2004 and 2017

https://doi.org/10.1016/j.amjcard.2022.01.047Get rights and content

Heart failure (HF) affects 6 million people in the United States and costs $30 billion annually. It is unclear whether improvements in length of stay and mortality over the last few decades hold true for both systolic and diastolic HF. To better assess the epidemiological and economic burden of HF, we assessed the trends in outcomes and costs for both systolic and diastolic HF. We identified hospitalizations for systolic and diastolic HF in the National Inpatient Sample database and evaluated trends over the period from 2004 to 2017, adjusting for demographics and co-morbidities. The proportion of patients admitted with an exacerbation of systolic HF increased from 42% to 63% over the study period. We found an overall decreasing trend between 2004 and 2011 in the length of stay for HF in general with a sharper decrease in diastolic than systolic HF. Inpatient mortality decreased between 2004 and 2007 and stabilized between 2008 and 2016. Systolic HF was associated with higher mortality than diastolic HF. The total inflation-adjusted cost did not change significantly over the study period, with systolic HF costing, on average, $3,036 more than diastolic HF per admission. In conclusion, systolic HF overtook diastolic HF, accounting for most HF hospitalizations in 2008. The higher hospitalization costs for systolic HF relative to diastolic HF may have resulted, in part, from greater use of advanced support devices in patients with systolic HF.

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Methods

The Nationwide Inpatient Sample (NIS) database is the single largest all-payer database of hospital discharges in the United States. It is a part of the Healthcare Quality and Utilization Project (HCUP) and sponsored by the Agency for Healthcare Research and Quality.7 The NIS is designed to represent a 20% stratified sample of community hospitals across the United States.7,8 The database is well-suited to identify patterns and national trends of health care costs and outcomes of specific

Results

A total of 6,403,626 HF hospitalizations were returned by our search criteria and included in this analysis. Of these, 60.3% were classified as systolic HF, while 39.7% were classified as diastolic HF. The overall characteristics of these cohorts are listed in Table 1. Patients hospitalized with diastolic HF were older, with a larger proportion being female and White, whereas Black patients made up a larger proportion of patients with systolic HF. Hypertension and obesity were more prevalent in

Discussion

In this nationally representative sample of systolic and/or diastolic HF hospitalizations in the United States from 2004 and 2017, there were approximately 60% admissions for systolic HF and 40% for diastolic HF. Recent publications have outlined an increase in the incidence of diastolic HF and a decrease in systolic HF over time, with an associated increase in the rate of hospitalization for diastolic HF.11, 12, 13, 14, 15 We found that even though the incidence of diastolic HF may be

Disclosures

The authors have no conflicts of interest to declare.

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