Temporal trends in the hospitalization and outcomes of patients with decompensated heart failure: Multicenter study

Background: The burden of illness of heart failure (HF) may be changing. We performed a study to define temporal trends in hospital admissions and long-term mortality among patients admitted with acute decompensated heart failure. Methods: We studied consecutive admissions with HF as a primary diagnosis at seven hospitals from 2000 to 2004. Admissions with a concurrent acute myocardial infarction were excluded from the analysis. Temporal trends in the etiology of HF, associated co-morbid conditions, medications and mortality were identified. Results: A total of 21,581 hospitalizations of 12,769 patients with primary diagnosis of HF were studied (average age 75). Monthly admission rate decreased by 10% over the study period, primarily due to a decrease in HF admissions of IHD etiology. Between 2000 and 2004 there was a significant increase in post-discharge purchase of beta-blockers (from 44.0% to 69.0%, p < 0.001) and statins (from 27.1% to 47.5%, p < 0.001). Mortality at 18 months post-discharge decreased from 38.9% to 33.9%. Multivariable analysis demonstrated that an annual mortality hazard decline could be explained by an increase in beta-blocker and statin use. Conclusions: The admission of acute HF patients of IHD, but not non-IHD etiology declined throughout the study period. Short term mortality remained stable throughout the study period, while there was a significant improvement in 18 month mortality rates. This reduction can be explained by higher utilization of the health services as can be manifested by an increase in statins and beta-blockers use.