Heart failure-related hospitalization in the U.S., 1979 to 2004.

OBJECTIVES The purpose of this study was to determine hospitalizations for heart failure in the U.S. during the past 26 years. BACKGROUND Heart failure increased in the U.S.; however, little is known about the long-term trends in diseases leading to hospitalizations among patients with heart failure. METHODS Using National Hospital Discharge Survey data from 1979 to 2004, we assessed trends in hospitalizations for heart failure as either a first-listed or additional (2nd to 7th) diagnosis. Among hospitalizations with any mention of heart failure, we assessed the distribution of first-listed diagnoses. RESULTS The number of hospitalizations with any mention of heart failure tripled from 1,274,000 in 1979 to 3,860,000 in 2004; 65% to 70% of admissions were patients with additional diagnoses of heart failure. Heart failure hospitalization rates increased sharply with age. More than 80% of hospitalizations were among patients of at least 65 years and were paid by Medicare/Medicaid. Age-adjusted hospitalization rates between 1979 and 2004 increased for heart failure as either the first-listed or additional diagnosis. Whereas heart failure was the first-listed diagnosis for 30% to 35% of these hospitalizations, the proportion with respiratory diseases and noncardiovascular, nonrespiratory diseases as the first-listed diagnoses increased. Heart failure hospitalizations that resulted in transfers to long-term care facilities increased, and in-hospital mortality and length of hospital stay declined. CONCLUSIONS With the increased aging of the U.S. population and advanced therapeutic interventions that improve survival, it is expected that heart failure hospitalizations at older ages and the associated economic burden to Medicare will continue to increase in the future.