The team also found that the rate of hospitalization for black men dropped at a lower rate, and that one-year mortality rates declined slightly during this period, but remained high.
Led by Dr. Jersey Chen, assistant professor of internal medicine at Yale School of Medicine, the study examined data from 55,097,390 fee-for-service Medicare beneficiaries hospitalized in the United States and Puerto Rico between 1998 and 2008 with a principal discharge diagnosis code for HF. The researchers set out to identify trends in the HF hospitalization rate and one-year mortality after HF hospitalization.
“Our data analysis revealed that there was a relative decline of 29.5 percent of the overall risk-adjusted HF hospitalization rate from 1998 to 2008,” said Chen. “Age-adjusted HF hospitalization rates declined over the study period for all race-sex categories, with black men having the lowest rate of decline.”
HF imposes one of the highest disease burdens of any medical condition in the United States and the risk increases with age. As a result, HF ranks as the most frequent cause of hospitalization and re-hospitalization among older Americans. HF is also one of the most resource-intensive conditions, with direct and indirect costs in the United States estimated at $39.2 billion in 2010.
The study showed that the HF hospitalization rates varied significantly by state. The decline in the hospitalization rate from 1998 to 2008 was significantly higher than the national average in 16 states and significantly lower in three states (Wyoming, Rhode Island, and Connecticut).
Chen and his team also found that risk-adjusted one-year mortality decreased from 31.7 percent to 29.6 percent between 1999 and 2008, a relative decline of 6.6 percent, with substantial variation by state. Four states had a statistically significant decline in one-year risk mortality between 1998 and 2008 while five states with a statistically significant increase.
“Because of the substantial decline in HF hospitalizations, compared to the rate of 1998, there were an estimated 229,000 fewer HF hospitalizations in 2008,” said Chen, who added that with a mean HF hospitalization cost of $18,000 in 2008, this decline represents a savings of $4.1 billion in fee-for-service Medicare.
“The overall decline in the heart failure hospitalization rate was mainly due to fewer individual patients being hospitalized with heart failure rather than a reduction in the frequency of repeat hospitalizations,” said Chen. “Also, the substantial geographic variation in heart failure hospitalization and one-year mortality rates represent marked differences in outcomes that are not explained by insurance status.”
Citation: JAMA 2011;306:1669-1678.