Chronic Disease

Chronic Disease: Heart failure hospitalization and mortality rates drop between 1998 and 2008

The heart failure (HF) hospitalization rate declined by 29.5 percent between 1998 and 2007, according to a national study by Jersey Chen, M.D., and a team of researchers from Yale and Harvard. The drop in HF hospitalization rates took place in all race and gender categories, with black men having the lowest rate of decline. However, HF hospitalization rates decreased significantly faster than the national mean in 16 States and significantly slower in 3 States. Overall HF mortality rates, adjusted for patient risk factors such as older age, ischemic heart disease, and hypertension, also declined from 31.7 percent in 1999 to 29.6 percent in 2008. One-year mortality rates declined significantly in four States, but rose in 5 States.

During the study period, there were changes in risk factors and clinical practice patterns that may explain the decline in HF hospitalizations, note the authors. For example, coronary heart disease has declined over time. Also, control of high blood pressure has improved modestly over time. Changes in secondary prevention (e.g., use of beta blockers or other medications) may reduce HF exacerbations leading to hospitalizations. Finally, trends favoring outpatient rather than inpatient management of HF may also have had an impact. The study included 55,097,390 fee-for-service Medicare beneficiaries hospitalized between 1998 and 2008 with a principal discharge diagnosis of HF. The study was supported in part by the Agency for Healthcare Research and Quality (HS18781).

See "National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries" by Jersey Chen, M.D., Sharon-Lise T. Normand, Ph.D., Yun Wang, Ph.D., and Harlan M. Krumholz, M.D., in the October 2011 Journal of the American Medical Association 306(15), pp. 1669-1678, 2011.

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