National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998-2008

JAMA. 2011 Oct 19;306(15):1669-78. doi: 10.1001/jama.2011.1474.

Abstract

Context: It is not known whether recent declines in ischemic heart disease and its risk factors have been accompanied by declines in heart failure (HF) hospitalization and mortality.

Objective: To examine changes in HF hospitalization rate and 1-year mortality rate in the United States, nationally and by state or territory.

Design, setting, and participants: From acute care hospitals in the United States and Puerto Rico, 55,097,390 fee-for-service Medicare beneficiaries hospitalized between 1998 and 2008 with a principal discharge diagnosis code for HF.

Main outcome measures: Changes in patient demographics and comorbidities, HF hospitalization rates, and 1-year mortality rates.

Results: The HF hospitalization rate adjusted for age, sex, and race declined from 2845 per 100,000 person-years in 1998 to 2007 per 100,000 person-years in 2008 (P < .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 (4142 to 3201 per 100,000 person-years) among all race-sex categories, which persisted after adjusting for age (incidence rate ratio, 0.81; 95% CI, 0.79-0.84). Heart failure hospitalization rates declined significantly faster than the national mean in 16 states and significantly slower in 3 states. Risk-adjusted 1-year mortality decreased from 31.7% in 1999 to 29.6% in 2008 (P < .001), a relative decline of 6.6%. One-year mortality rates declined significantly in 4 states but increased in 5 states.

Conclusions: The overall HF hospitalization rate declined substantially from 1998 to 2008 but at a lower rate for black men. The overall 1-year mortality rate declined slightly over the past decade but remains high. Changes in HF hospitalization and 1-year mortality rates were uneven across states.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • African Americans / statistics & numerical data
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Comorbidity
  • Female
  • Heart Failure / mortality*
  • Heart Failure / therapy*
  • Hospitalization / trends*
  • Hospitals / statistics & numerical data
  • Humans
  • Male
  • Medicare / statistics & numerical data*
  • Mortality / trends
  • Retrospective Studies
  • Sex Factors
  • United States / epidemiology