TY - JOUR
T1 - National trends in admission and in-hospital mortality of patients with heart failure in the United States (2001-2014)
AU - Akintoye, Emmanuel
AU - Briasoulis, Alexandros
AU - Egbe, Alexander
AU - Dunlay, Shannon M.
AU - Kushwaha, Sudhir
AU - Levine, Diane
AU - Afonso, Luis
AU - Mozaffarian, Dariush
AU - Weinberger, Jarrett
N1 - Funding Information:
This study was conducted using the National Inpatient Sample (NIS) of the Health Care Utilization Project sponsored by the Agency for Healthcare Research and Quality. Details of the design and description of the NIS are available online.11 Briefly, this nationally representative database, which represents the largest all-payer inpatient care database in the United States, contains yearly encounter-level information of hospital stays compiled in a uniform format, with privacy protection of individual patients. NIS approximates a 20% stratified sample of discharges from nonfederal, short-term, general, and other specialty hospitals in the United States. To derive national estimates from the sample, the Agency for Healthcare Research and Quality provides a trend/discharge weight that accounted for the sampling design.
Funding Information:
This project received financial support through the Wayne State University Library System Open Access Fund Award.
Publisher Copyright:
© 2017 The Authors.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Background--To investigate heart failure (HF) hospitalization trends in the United States and change in trends after publication of management guidelines. Methods and Results--Using data from the National Inpatient Sample and the US Census Bureau, annual national estimates in HF admissions and in-hospital mortality were estimated for years 2001 to 2014, during which an estimated 57.4 million HF-associated admissions occurred. Rates (95% confidence intervals) of admissions and in-hospital mortality among primary HF hospitalizations declined by an average annual rate of 3% (2.5%-3.5%) and 3.5% (2.9%-4.0%), respectively. Compared with 2001 to 2005, the average annual rate of decline in primary HF admissions was more in 2006 to 2009 (ie, 3.4% versus 1.1%; P=0.02). In 2010 to 2014, primary HF admission continued to decline by an average annual rate of 4.3% (95% confidence interval, 3.9%-5.1%), but this was not significantly different from 2006 to 2009 (P=0.14). In contrast, there was no further decline in in-hospital mortality trend after the guideline-release years. For hospitalizations with HF as the secondary diagnosis, there was an upward trend in admissions in 2001 to 2005. However, the trend began to decline in 2006 to 2009, with an average annual rate of 2.4% (95% confidence interval, 0.8%-4%). Meanwhile, there was a consistent decline in in-hospital mortality by an average annual rate of 3.7% (95% confidence interval, 3.3%-4.2%) during the study period, but the decline was more in 2006 to 2009 compared with 2001 to 2005 (ie, 5.4% versus 3.4%; P < 0.001). Beyond 2009, admission and in-hospital mortality rates continued to decline, although this was not significantly better than the preceding interval. Conclusions--From 2001 to 2014, HF admission and in-hospital mortality rates declined significantly in the United States; the greatest improvements coincided with the publication of the 2005 American College of Cardiology/American Heart Association HF guidelines.
AB - Background--To investigate heart failure (HF) hospitalization trends in the United States and change in trends after publication of management guidelines. Methods and Results--Using data from the National Inpatient Sample and the US Census Bureau, annual national estimates in HF admissions and in-hospital mortality were estimated for years 2001 to 2014, during which an estimated 57.4 million HF-associated admissions occurred. Rates (95% confidence intervals) of admissions and in-hospital mortality among primary HF hospitalizations declined by an average annual rate of 3% (2.5%-3.5%) and 3.5% (2.9%-4.0%), respectively. Compared with 2001 to 2005, the average annual rate of decline in primary HF admissions was more in 2006 to 2009 (ie, 3.4% versus 1.1%; P=0.02). In 2010 to 2014, primary HF admission continued to decline by an average annual rate of 4.3% (95% confidence interval, 3.9%-5.1%), but this was not significantly different from 2006 to 2009 (P=0.14). In contrast, there was no further decline in in-hospital mortality trend after the guideline-release years. For hospitalizations with HF as the secondary diagnosis, there was an upward trend in admissions in 2001 to 2005. However, the trend began to decline in 2006 to 2009, with an average annual rate of 2.4% (95% confidence interval, 0.8%-4%). Meanwhile, there was a consistent decline in in-hospital mortality by an average annual rate of 3.7% (95% confidence interval, 3.3%-4.2%) during the study period, but the decline was more in 2006 to 2009 compared with 2001 to 2005 (ie, 5.4% versus 3.4%; P < 0.001). Beyond 2009, admission and in-hospital mortality rates continued to decline, although this was not significantly better than the preceding interval. Conclusions--From 2001 to 2014, HF admission and in-hospital mortality rates declined significantly in the United States; the greatest improvements coincided with the publication of the 2005 American College of Cardiology/American Heart Association HF guidelines.
KW - Heart failure
KW - Hospitalization
KW - Mortality
KW - Outcome
KW - Quality of care
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U2 - 10.1161/JAHA.117.006955
DO - 10.1161/JAHA.117.006955
M3 - Article
C2 - 29187385
AN - SCOPUS:85038844937
SN - 2047-9980
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 12
M1 - e006955
ER -