The Expanding National Burden of Heart Failure in the U.S.
The Expanding National Burden of Heart Failure in the U.S.
Background: Although some studies have shown that hospital admissions for heart failure doubled between 1973 and 1995, other data suggest that the heart failure hospitalization epidemic has stabilized in the United States. We sought to describe trends in heart failure hospitalizations over the past decade using data from the National Hospital Discharge Survey (NHDS).
Methods: The NHDS provides annual estimates of hospitalization discharges from a sample of hospitals in the United States. We combined the heart failure hospitalization frequencies with census estimates to calculate age and gender-specific annual hospitalization rates.
Results: Hospitalizations with a primary diagnosis of heart failure among adults (age ≥35) increased from 810,624 in 1990 to 989,500 in 1995 (annual increase 36,088, R = 0.816, P = .014), and to 1,088,349 in 1999 (annual increase 31,091, R = 0.780, P = .047). The age-adjusted hospitalization rate (per 1000 persons) increased from 7.186 in 1990 to 8.554 in 1999 for women (annual increase 0.14/year, R = 0.731, P = .002) and from 6.892 in 1990 to 7.372 in 1999 for men (annual increase 0.011/year, R = 0.008, P = 0.80). For women, the annual hospitalization rate increased from 1990 to 1999 in each age group (35-64, 65-74, 75-84, and ≥85), while the age-specific rates did not change in men.
Conclusions: Heart failure hospitalizations have continued to increase from 1990 to 1999. Although aging and growth of the US population contribute to this trend, the increases are substantially influenced by changes in hospitalization rates in women.
Heart failure is a major public health problem in the United States and prior studies have shown that the incidence of hospital admission for heart failure has increased over 100% from 1973 to 1995. The cause of this increased incidence has been hypothesized by many to be due to the age dependency of heart failure and improved treatment and survival from ischemic heart disease.
However, some data suggest that the heart failure hospitalization "epidemic" has peaked in certain geographic regions. A review of the National Hospital Discharge Survey (NHDS) from 1985 to 1995 by Haldeman et al showed that the number of heart failure hospitalizations appeared to reach a plateau in the years 1993 to 1995. One possible explanation for these findings is the increased use of medications known to reduce the rate of hospitalizations in heart failure patients. However, it is unclear if this stabilization has persisted in recent years with the aging of the population and the increasing prevalence of underlying risk factors for heart failure such as diabetes, hypertension, and obesity, particularly in women. The goals of this study were to determine if the rate of heart failure hospitalizations has continued to increase over the past decade, and define the relative contribution of gender to the rate of heart failure hospitalization in the United States.
Background: Although some studies have shown that hospital admissions for heart failure doubled between 1973 and 1995, other data suggest that the heart failure hospitalization epidemic has stabilized in the United States. We sought to describe trends in heart failure hospitalizations over the past decade using data from the National Hospital Discharge Survey (NHDS).
Methods: The NHDS provides annual estimates of hospitalization discharges from a sample of hospitals in the United States. We combined the heart failure hospitalization frequencies with census estimates to calculate age and gender-specific annual hospitalization rates.
Results: Hospitalizations with a primary diagnosis of heart failure among adults (age ≥35) increased from 810,624 in 1990 to 989,500 in 1995 (annual increase 36,088, R = 0.816, P = .014), and to 1,088,349 in 1999 (annual increase 31,091, R = 0.780, P = .047). The age-adjusted hospitalization rate (per 1000 persons) increased from 7.186 in 1990 to 8.554 in 1999 for women (annual increase 0.14/year, R = 0.731, P = .002) and from 6.892 in 1990 to 7.372 in 1999 for men (annual increase 0.011/year, R = 0.008, P = 0.80). For women, the annual hospitalization rate increased from 1990 to 1999 in each age group (35-64, 65-74, 75-84, and ≥85), while the age-specific rates did not change in men.
Conclusions: Heart failure hospitalizations have continued to increase from 1990 to 1999. Although aging and growth of the US population contribute to this trend, the increases are substantially influenced by changes in hospitalization rates in women.
Heart failure is a major public health problem in the United States and prior studies have shown that the incidence of hospital admission for heart failure has increased over 100% from 1973 to 1995. The cause of this increased incidence has been hypothesized by many to be due to the age dependency of heart failure and improved treatment and survival from ischemic heart disease.
However, some data suggest that the heart failure hospitalization "epidemic" has peaked in certain geographic regions. A review of the National Hospital Discharge Survey (NHDS) from 1985 to 1995 by Haldeman et al showed that the number of heart failure hospitalizations appeared to reach a plateau in the years 1993 to 1995. One possible explanation for these findings is the increased use of medications known to reduce the rate of hospitalizations in heart failure patients. However, it is unclear if this stabilization has persisted in recent years with the aging of the population and the increasing prevalence of underlying risk factors for heart failure such as diabetes, hypertension, and obesity, particularly in women. The goals of this study were to determine if the rate of heart failure hospitalizations has continued to increase over the past decade, and define the relative contribution of gender to the rate of heart failure hospitalization in the United States.
