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Significant and constant increase in hospitalization due to heart failure in Spain over 15 year period

Published:March 01, 2019DOI:https://doi.org/10.1016/j.ejim.2019.02.019

      Highlights

      • In Spain (2001–2015) we found a significant increase of hospitalizations due to HF.
      • Patients hospitalized with HF are becoming older and with more comorbidities.
      • In hospital mortality in HF patients has decreased significantly overtime.
      • 30-day readmission rates have remained stable overtime for HF patients.

      Abstract

      Background

      To examine trends in the incidence, characteristics, and in-hospital outcomes of heart failure (HF) hospitalizations from 2001 to 2015 in Spain.

      Methods

      Using the Spanish National Hospital Discharge Database (SNHDD) we selected admissions with a primary or secondary diagnosis of HF. The primary end points were trends in the incidence of hospitalizations and in-hospital mortality (IHM). Trends with primary and secondary diagnosis of HF were evaluated separately.

      Results

      The incidence of HF coding increased significantly from 466.16 cases per 100,000 inhabitants in 2001–03 to 780.4 in 2013–15 (p < .001). Age increased over time (76.33 ± 10.92 years in 2001–03 vs. 79.4 ± 10.78 years in 2013–15; p < .001). We found a decrease in the percentage of women over the study period (53.07% vs. 52%; p < .001). We detected a significant increase in comorbidity according to the Charlson Comorbidity Index over time (mean 2.17 ± 0.98 in 2001–03 vs. 2.46 ± 1.04 in 2013–15). The most common associated comorbidities were atrial fibrillation (42.23%), hypertension (38.87%) and type 2 diabetes (34.3%). For the total time period, IHM was 12.79%. IHM decreased significantly over time from 13.47% in 2001–03 to 12.30% in 2013–15. Patients with HF coded as a secondary diagnosis have 66% higher risk of dying in the hospital that those with HF coded as a primary diagnosis.

      Conclusions

      This research shows an increase of hospitalizations due to HF in Spain, particularly in patients with HF as a secondary diagnosis. Advance age and comorbidity in acute HF has increased in the recent years. However, IHM is decreasing while readmissions remain stable.

      Keywords

      Abbreviations:

      ACC (American College of Cardiology), AHA (American Heart Association), APC (annual percentage of change), CCI (Charlson comorbidity index), COPD (chronic obstructive pulmonary disease), ER (emergency room), HF (heart failure), ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), IHM (in-hospital mortality), LOHS (length of hospital stay), OR (Odds Ratio), SNHDD (Spanish National Hospital Discharge Database), TD2M (type 2 diabetes mellitus)
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