Hospitalizations rose for acute decompensated heart failure in past decade

The analysis of heart failure-related hospitalizations in U.S. patients age 55 years and older between 2005 and 2014 found that only black patients showed decreased one-year mortality over time.

Hospitalizations for acute decompensated heart failure (HF) increased between 2005 and 2014, but survival rates improved for black patients.

The Atherosclerosis Risk in Communities (ARIC) Study sampled HF-related hospitalizations among patients age 55 years and older in four U.S. communities using ICD-9-CM codes. Hospitalizations were validated by standardized physician review and/or computer algorithm, yielding 40,173 events after accounting for sampling design. Results were published online by Circulation on March 8.

Of the acute decompensated HF hospitalizations, 50% of patients had reduced ejection fraction and 39% had preserved ejection fraction. Reduced ejection fraction was more common in black men and white men, whereas preserved ejection fraction was most common in white women. Average age-adjusted rates of acute decompensated HF were highest in black patients (38.1 per 1,000 black men, 30.5 per 1,000 black women), with rates differing by HF type and sex.

Acute decompensated HF rates increased over the 10 years, with average annual percent changes (AAPC) of 4.3% in black women, 3.7% in black men, 1.9% in white women, and 2.6% in white men. These figures mostly reflect more acute preserved ejection fraction HF, the authors wrote. Age-adjusted 28-day and one-year case-fatality proportions were approximately 10% and 30%, respectively, and they were similar across race-sex groups and HF types.

Only black patients showed decreased one-year mortality over time (AAPC, −5.4% for black women and −4.6% for black men), with rates differing by heart failure type (AAPC, −7.1% for black women with preserved ejection fraction and −4.7% for black men with reduced ejection fraction). Survival at one year was poor regardless of ejection fraction but improved over time for black patients, the authors noted.

“Given the focus of providers, payors, and health care systems to decrease readmission rates for ADHF [acute decompensated heart failure], seeing these survival trends in both first and recurrent hospitalized ADHF may translate to more attention on the medical management of hospitalized patients with HF,” the authors wrote.