National trends in the initial hospitalization for heart failure.
OBJECTIVE
Heart failure is a major health care burden among older adults, but information on recent trends has not been available. We compare rates, sociodemographic characteristics, and discharge outcomes of the initial hospitalization for heart failure in the Medicare populations of 1986 and 1993.


METHODS
Information reported on the Medicare hospital claims record during initial hospitalization for heart failure was compared for patients aged 65 and older hospitalized in 1986 (N = 631,306) and those aged 65 and older hospitalized in 1993 (N = 803,506).


RESULTS
Age-standardized hospitalization rates (per 1000 person-years) for any diagnosis of heart failure were higher in 1993 than in 1986 (white: 24.6 vs 22.4, black: 26.1 vs 22.4, respectively). Age-specific results suggested an earlier onset of heart failure in black adults. In 1993, compared with 1986, higher proportions of heart failure patients were discharged to another care facility (white: 23.9% vs 16.8%, black: 17.6% vs 10.5%, respectively) or to health service care at home (white: 11.3% vs 6.0%, black: 12.4% vs 6.5%, respectively). In contrast, in-hospital mortality was lower in 1993 than in 1986 (white: 10.4% vs 13.3%, black: 8.9% vs 11.1%, respectively).


CONCLUSIONS
The increased numbers of hospitalizations for heart failure and the likelihood that these patients will require advanced nursing care after discharge have important implications for future national health care expenditures and resources.
Croft
J B
JB
Cardiovascular Health Studies Branch, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
Giles
W H
WH
Pollard
R A
RA
Casper
M L
ML
Anda
R F
RF
Livengood
J R
JR
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008297:Male; D016344:Medicare Part A / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000639:trends; D044469:Racial Groups; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology