Heart Failure Care Improving, but Hospitalizations on the Rise

Although hospitalizations have increased in recent years for patients with congestive heart failure, survival rates and length of stay have improved, according to new research from experts at the University of Pittsburgh School of Medicine and UPMC Heart and Vascular Institute. The results, published in the journal Clinical Cardiology and presented Sunday at the American Heart Association Scientific Sessions, were based on more than 15 million US hospital admissions between 1996 and 2009 due to congestive heart failure.

The prevalence of heart failure is increasing in the US due to its aging population and significant advancements in management of associated co-morbidities, such as ischemic heart disease, diabetes, stroke, peripheral vascular disease and hypertension. More than 5 million Americans are living with heart failure, and close to 500,000 patients are newly diagnosed each year.

Heart failure also is a common cause of hospital admissions, leading to significant costs for the nation’s health care system. A recent report from the American Heart Association estimated the annual direct and indirect costs associated with heart failure in the US at more than $30.7 billion. However, until this study, little was known about recent trends involving those admissions, including length of stay and in-hospital mortality.

“There has been significant progress in heart failure management over the past two decades, but more has to be done,” said Muhammad Bilal Munir, MD, clinical instructor of medicine in Pitt’s Division of General Internal Medicine and corresponding author of the study. “The number of hospitalizations has increased, identifying a need to implement heart failure quality measures stringently to reduce these admissions, therefore reducing heart failure-associated health care costs.”

The number of heart failure hospitalizations increased from 1,000,766 in 1996 to about 1,173,832 in 2009, according to study results. The mean length of stay fell from 6.07 days in 1996 to about 5.26 days in 2009, and inpatient mortality rates declined from 4.92 percent in 1996 to 3.41 percent in 2009.

Researchers say the findings likely reflect the changes in the management of heart failure across the country, which include numerous advances in care such as new drug therapies and sophisticated devices. Further efforts are needed to curb the cost of heart failure management, experts agreed, with a focus on reducing heart failure hospital admissions and readmissions, especially for patients with less severe symptoms who could be treated with aggressive outpatient management.

Additional study authors are Michael S. Sharbaugh, MPH; Floyd W. Thoma; Muhammad Umer Nisar, MD; Amir S. Kamran, MD; Andrew D. Althouse, PhD; and Samir Saba, MD, all from the UPMC Heart and Vascular Institute.