TY - JOUR
T1 - Heart failure-associated hospitalizations in the United States
AU - Blecker, Saul
AU - Paul, Margaret
AU - Taksler, Glen
AU - Ogedegbe, Gbenga
AU - Katz, Stuart
N1 - Funding Information:
The Nationwide Inpatient Sample (NIS) is part of the Healthcare Cost and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality (AHRQ) ( 17 ). The NIS represents the largest all-payer hospitalization database in the United States and samples approximately 8 million hospitalizations per year to represent national estimates. We included all heart failure hospitalizations between 2001 and 2009 for patients ≥18 years of age. The primary unit of analysis was a patient hospitalization. Individual patients cannot be tracked longitudinally in the NIS; thus, a patient might have contributed to more than 1 observation in a given year. Heart failure was based on the following International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) discharge diagnosis codes in any position: 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, and 428 ( 18 ). If 1 of these codes was listed in the first position, the admission was considered to be a primary heart failure hospitalization; otherwise, the admission was considered to be a secondary heart failure hospitalization. The NIS abstracts up to 15 discharge diagnosis codes, although actual hospitalizations may list more diagnoses ( 17 ). All patient and hospital characteristics were obtained from the NIS. Patient characteristics included demographic and outcome characteristics and comorbidities. Age was presented as a continuous variable and categorized as 18 to 49, 50 to 64, 65 to 74, 75 to 84, and ≥85 years of age. Race was categorized as white, black, or other. The primary payer for the hospitalization was categorized as Medicare, Medicaid, private insurance, self-pay, or other. Number of chronic conditions was defined by summing the Elixhauser comorbidity index ( 19 ), and individual comorbidities were assessed using the HCUP Clinical Classification Software (CCS) definitions ( 20 ). Hospital characteristics included region of the country and rural versus urban density. Region of the country was categorized as Northeast, Midwest, South, or West. Rural region was based on Metropolitan Statistical Area codes before 2004 and Core Based Statistical Area codes beginning in 2004 ( 17 ). Hospitalization type was based on principal discharge diagnosis. We categorized hospitalizations as heart failure (using the previously described codes), cardiovascular (ICD-9-CM codes between 390 and 459, with the exception of those for heart failure), and noncardiovascular (all other codes). Hospitalizations were also described based on both individual and multilevel CCS categories. Finally, we identified the top 10 CCS categories that were listed as the primary discharge diagnoses. Outcome-related measures were presented separately for both primary and secondary heart failure diagnoses and included in-hospital mortality, length of stay, and discharge disposition. Discharge disposition was categorized as routine, intermediate care transfers, and home health care.
PY - 2013/3/26
Y1 - 2013/3/26
N2 - Objectives: This study sought to characterize temporal trends in hospitalizations with heart failure as a primary or secondary diagnosis. Background: Heart failure patients are frequently admitted for both heart failure and other causes. Methods: Using the Nationwide Inpatient Sample (NIS), we evaluated trends in heart failure hospitalizations between 2001 and 2009. Hospitalizations were categorized as either primary or secondary heart failure hospitalizations based on the location of heart failure in the discharge diagnosis. National estimates were calculated using the sampling weights of the NIS. Age- and sex-standardized hospitalization rates were determined by dividing the number of hospitalizations by the U.S. population in a given year and using direct standardization. Results: The number of primary heart failure hospitalizations in the United States decreased from 1,137,944 in 2001 to 1,086,685 in 2009, whereas secondary heart failure hospitalizations increased from 2,753,793 to 3,158,179 over the same period. Age- and sex-adjusted rates of primary heart failure hospitalizations decreased steadily from 2001 to 2009, from 566 to 468 per 100,000 people. Rates of secondary heart failure hospitalizations initially increased from 1,370 to 1,476 per 100,000 people from 2001 to 2006, then decreased to 1,359 per 100,000 people in 2009. Common primary diagnoses for secondary heart failure hospitalizations included pulmonary disease, renal failure, and infections. Conclusions Although primary heart failure hospitalizations declined, rates of hospitalizations with a secondary diagnosis of heart failure were stable in the past decade. Strategies to reduce the high burden of hospitalizations of heart failure patients should include consideration of both cardiac disease and noncardiac conditions.
AB - Objectives: This study sought to characterize temporal trends in hospitalizations with heart failure as a primary or secondary diagnosis. Background: Heart failure patients are frequently admitted for both heart failure and other causes. Methods: Using the Nationwide Inpatient Sample (NIS), we evaluated trends in heart failure hospitalizations between 2001 and 2009. Hospitalizations were categorized as either primary or secondary heart failure hospitalizations based on the location of heart failure in the discharge diagnosis. National estimates were calculated using the sampling weights of the NIS. Age- and sex-standardized hospitalization rates were determined by dividing the number of hospitalizations by the U.S. population in a given year and using direct standardization. Results: The number of primary heart failure hospitalizations in the United States decreased from 1,137,944 in 2001 to 1,086,685 in 2009, whereas secondary heart failure hospitalizations increased from 2,753,793 to 3,158,179 over the same period. Age- and sex-adjusted rates of primary heart failure hospitalizations decreased steadily from 2001 to 2009, from 566 to 468 per 100,000 people. Rates of secondary heart failure hospitalizations initially increased from 1,370 to 1,476 per 100,000 people from 2001 to 2006, then decreased to 1,359 per 100,000 people in 2009. Common primary diagnoses for secondary heart failure hospitalizations included pulmonary disease, renal failure, and infections. Conclusions Although primary heart failure hospitalizations declined, rates of hospitalizations with a secondary diagnosis of heart failure were stable in the past decade. Strategies to reduce the high burden of hospitalizations of heart failure patients should include consideration of both cardiac disease and noncardiac conditions.
KW - Comorbidity
KW - Heart failure
KW - Hospitalizations
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U2 - 10.1016/j.jacc.2012.12.038
DO - 10.1016/j.jacc.2012.12.038
M3 - Article
C2 - 23500328
AN - SCOPUS:84877254326
SN - 0735-1097
VL - 61
SP - 1259
EP - 1267
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 12
ER -