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National and Regional Trends in Heart Failure Hospitalization and Mortality Rates for Medicare Beneficiaries, 1998-2008
Study Questions:
What are the recent changes in heart failure (HF) hospitalization rate and 1-year mortality rate in the United States, nationally and by state or territory?
Methods:
Patients were recruited from acute care hospitals in the United States and Puerto Rico; 55,097,390 fee-for-service Medicare beneficiaries were hospitalized between 1998 and 2008, with a principal discharge diagnosis code for HF. The main outcome measures were changes in patient demographics and comorbidities, HF hospitalization rates, and 1-year mortality rates. Risk-adjusted HF hospitalization and mortality rates were calculated for each year that represented what the rate would have been if the mix of patients were identical to the initial year (i.e., 1998 for HF hospitalization, 1999 for 1-year mortality) using dummy indicator variables for each year from the regression models.
Results:
The HF hospitalization rate adjusted for age, sex, and race declined from 2,845 per 100,000 person-years in 1998 to 2,007 per 100,000 person-years in 2008 (p < 0.001), a relative decline of 29.5%. Age-adjusted HF hospitalization rates declined over the study period for all race-sex categories. Black men had the lowest rate of decline (4,142 to 3,201 per 100,000 person-years) among all race-sex categories, which persisted after adjusting for age (incidence rate ratio, 0.81; 95% confidence interval, 0.79-0.84). HF hospitalization rates declined significantly faster than the national mean in 16 states and significantly slower in three states. Risk-adjusted 1-year mortality decreased from 31.7% in 1999 to 29.6% in 2008 (p < 0.001), a relative decline of 6.6%. One-year mortality rates declined significantly in four states, but increased in five states.
Conclusions:
The authors concluded that the overall HF hospitalization rate declined substantially from 1998 to 2008 and the overall 1-year mortality rate declined slightly over the past decade, but remains high.
Perspective:
This study found a relative 29.5% decline in the risk-adjusted HF hospitalization rate from 1998 to 2008 that was primarily the result of fewer unique individuals hospitalized for HF. However, black men had the lowest rate of decline for HF hospitalization among race-sex groups. Risk-adjusted 1-year mortality with HF hospitalization declined only slightly in the same time period. Even though this analysis suggests that the rates of HF hospitalization may have declined in recent years, the overall mortality rate and readmission rate for HF continue to remain unacceptably high, suggesting the need for newer approaches and therapies. The regional and racial differences in hospitalization rates call for additional studies to better understand these disparities.
Keywords: Heart Failure, Hospitalization, United States
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