National Trends in Heart Failure Hospital Stay Rates, 2001 to 2009
What are trends in heart failure (HF) hospital stay rates, length of stay (LOS), and in-hospital mortality by age groups, gender, and race in a national all-payer database of hospital discharges in the United States?
This was a retrospective analysis of the National Inpatient Sample (NIS), collected by the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project and identified as the largest all-payer inpatient database publicly available in the United States. Survey data analysis techniques were used to calculate HF hospital stay rates (for the overall cohort and for subgroups of age as population-based HF hospital stay rates/100,000 persons for each calendar year), LOS, and in-hospital mortality rates from 2001 to 2009. Secondary analyses stratified by race-sex categories were conducted in a subset of patients hospitalized in states that reported complete data on patient race across all years to the NIS. All p values were two-sided, with a significance threshold of p < 0.001.
The cohort consisted of 1,686,089 hospital stays for a principal discharge diagnosis of HF. The national HF hospital stay rate declined from 633 to 463 hospital stays/100,000 persons from 2001 to 2009 (a relative 26.9% decrease, p for trend < 0.001). Statistically significant declines were only observed for patients 55-64 years of age (-36.5%), 65-74 years (-37.4%), and ≥75 years (-28.3%), but not for patients 18-44 years of age (-12.8%, p = 0.57) or 45-55 years (-16.2%, p = 0.04). Observed mean LOS for HF hospital stay declined from 5.6 days to 5.3 days (a relative 6.4% decline, p for trend < 0.001); statistically significant declines in LOS, however, were only observed for patients 75 years of age and older. Observed in-hospital mortality for HF patients fell from 4.5% to 3.3% (a relative 27.4% decrease, p for trend < 0.001). Statistically significant reductions in in-hospital mortality were observed for patients 45-54 years, 55-64 years, 65-74 years, and 75 years of age or older; patients 18-44 years of age did not exhibit a significant decline in in-hospital mortality (-8.1%, p = 0.18). Significant declines in HF hospital stay rate were observed for white men, white women, and black women, but not for black men (-9.5%, p for trend = 0.43). All race-sex groups did exhibit statistically significant declines in in-hospital mortality.
Although there have been expected gains in HF hospital stay rates, LOS, and in-hospital mortality in the past decade, younger patients have not experienced comparable declines in these metrics, when compared to older adults. Furthermore, HF hospital stay rates have not significantly declined for black men, although all race-sex groups have demonstrated statistically significant declines in in-hospital mortality.
This analysis adds to the growing literature on trends and patterns of hospital care use among patients with HF. The authors demonstrated that the overall national HF hospital stay rate fell by a relative 26.9% from 2001 to 2009, similar to the 29.5% decrease in HF hospital stay rates observed in the Medicare population from 1998 to 2008. However, the authors add to these established findings by pointing out the heterogeneity in outcomes by age groups. Younger patients have not experienced the same magnitude of declines in HF hospital stay, LOS, or in-hospital mortality, compared to older patients. These observations warrant further study and attention in clinical practice. The authors have also identified Black men as a particularly vulnerable population, in whom there has been no significant decline in HF hospital stay over the past decade (although all race-sex groups in this study did demonstrate statistically significant declines in in-hospital mortality). It will be imperative to understand and address this disparity, likely through better risk factor management in this population.
Keywords: Hospital Mortality, Continental Population Groups, European Continental Ancestry Group, Health Services Research, Health Care Costs, Risk Factors, Inpatients, Length of Stay, Risk Management, Vulnerable Populations, Heart Failure, Medicare, African Continental Ancestry Group, Hospitalization, Gender Identity, United States
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