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.
Novack
V
V
Department of Internal Medicine, Soroka University Medical Center, Beer-Sheva, Israel. victor.novack@hcri.harvard.edu
Jotkowitz
A
A
Porath
A
A
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000401:mortality*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*
D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors