A new analysis of national hospitalization trends for heart failure shows both positive and negative changes, according to a study published March 4 in the Journal of the American College of Cardiology. The overall length of stay for heart failure has declined, but trends are not uniform across the population. Younger patients have not experienced the same declines as older patients, and African-American men remain a more vulnerable population for heart failure hospitalization.

Researchers analyzed data from the Agency for Healthcare Research and Quality’s National Inpatient Sample (NIS), the largest all-payer national data set of acute hospital stays. The sample represents an estimated 8,249,759 heart failure hospitals stays nationwide from 2001 to 2009.

The overall national heart failure hospital stay rate declined from 633 per 100,000 persons in 2001 to 463 per 100,000 in 2009, a relative decrease of 26.9 percent (p<0.001). There were statistically significant declines in heart failure hospitalization rates for all age-based subgroups of patients 55 years and older. But there were no significant changes in heart failure hospitalization rates for patients aged 18-44 (-12.8 percent, p=0.57) or those aged 45-54 (-16.2 percent, p=0.04). Further, the heart failure hospitalization rate fell significantly for women over the course of the study (from 676 to 457/100,000 persons, −32.3 percent, p-for-trend <0.0001) and also declined for men but did not reach statistical significance (from 588 to 469/100,000 persons, −20.2 percent, p-for-trend = 0.003).

Only 20 of 44 states reported ethnic/racial data, but data from reporting states showed an overall decline in heart hospitalization of 24.7 percent (p<0.001), comparable to results from the full dataset. There were statistically significant declines for white women (-33.5 percent), African-American women (-30.9 percent), but non-significant declines for white men (-24.7 percent, p=0.003) and African-American men (-9.5 percent, p=0.43).

The mean hospital length of stay (LOS) declined from 5.6 days in 2001 to 5.3 days in 2009, a decline of 6.4 percent (p<0.001). When analyzed by age, only patients aged 75 and older showed a significant decline in LOS (-8.5 percent, p<0.001). When assessed by insurance states, only Medicare patients showed a significant decline in LOS (-8.5 percent, p<0.001). Mean LOS declined significantly for white and African-American women and white men, but not for African-American men. In-hospital mortality declined significantly for all groups analyzed by age, race and insurance status.

"Although the overall reduction in the heart failure hospital stay rate represents a success, our findings illustrate that challenges remain," note the authors. More effective control of heart failure risk factors in older patients may account for the greater reductions in hospitalization and LOS compared to younger patients, they add.

Specifically, "black men remain a vulnerable group with no significant decline in heart failure hospital stay rates over the past decade," add the authors. "We speculate that black men had a slower rate of decline in part to due differences in risk factor management."

"This study provides further evidence of the extraordinary progress we are making in cardiology, as the rates of admission for HF are declining at an astounding pace," said Harlan Krumholz, MD, SM, FACC, co-author of the study and Harold H. Hines Jr. professor of medicine and epidemiology and public health at the Yale University School of Medicine. "Amid this good news, the study also shows that we need to focus attention on the disparities that persist." "Specifically, more work remains to be done on why the decline appears less steep for black men," added Jersey Chen, MD, lead author of the study.

Keywords: Hospital Mortality, European Continental Ancestry Group, Health Services Research, Risk Factors, Inpatients, Universities, Length of Stay, Public Health, Vulnerable Populations, Heart Failure, Medicare, African Continental Ancestry Group, Hospitalization, United States