National Trends and Disparities in Heart Failure Hospitalizations and Inpatient Outcomes Between 2010-2022

Abstract

Background: Limited data exist on trends and differential heart failure (HF) hospitalization rates, particularly when appropriate statistical age standardization is applied.

Objectives: This study aimed to assess temporal trends in age-standardized hospitalization rates and in-hospital mortality for primary HF hospitalizations among younger (<65 years) and older (>64 years) patients, stratified by sex, race/ethnicity, insurance status, and urban/rural hospital location.

Methods: The National Inpatient Sample database was analyzed to identify adults who were hospitalized for HF between 2010 and 2022. HF hospitalization rates and in-hospital mortality trends were then examined across demographic strata.

Results: In total, 14,287,733 weighted hospitalizations for HF were identified. Overall, age-standardized HF hospitalizations per 100,000 U.S. population showed a nonsignificant change from 406 in 2010 to 381 in 2014 (P = 0.14), followed by an increase to 447 in 2018 (P = 0.002) and a subsequent decline to 395 in 2022 (P = 0.002). Hospitalization rates declined at rural hospitals but increased among Medicare and Medicaid insurers (P < 0.05). From 2010 to 2022, the <65-year age group experienced increasing hospitalizations (from 124 to 161; average annual percentage change: 2.2 [95% CI: 1.6-2.8]; P < 0.001) in contrast to the >64-year age group (from 1,775 to 1,525; average annual percentage change: -1.2; 95% CI: -2.8 to 0.9). In-hospital mortality for the overall cohort did not improve between 2010 and 2022, and with a significant uptrend observed in 2020 compared with the 2010-2019 period (P = 0.001).

Conclusions: This longitudinal analysis of U.S. hospitalizations from 2010 to 2022 revealed that HF hospitalizations began increasing in 2014, peaked in 2019, and then declined sharply in 2020, a trend that persisted through 2022, with a more pronounced decline among adults aged >64 years. In contrast, HF hospitalizations among adults aged <65 years continued to rise, highlighting a shift in epidemiological landscape in which HF increasingly affects younger populations. In-hospital mortality increased in 2020, changing the trend observed in prior years.

Keywords: HCUP; demographics; heart failure; outcomes; trends.