Heart failure outcomes remain steady in US

Although efforts to reduce heart failure (HF)-related deaths and readmissions in the United States were successful in the early 2000s, rates of HF-related ER visits, comorbid hospitalizations and mortality are at a standstill in 2018, according to a nationwide study published Dec. 11 in Circulation: Heart Failure.

The burden of HF in the U.S., while known to be considerable, isn’t quantified or surveilled comprehensively by national authorities, first author Sandra L. Jackson, PhD, MPH, and colleagues wrote in the journal. And with a growing population of older Americans and a projected 46 percent increase in HF between 2012 and 2030, that’s a problem.

“Evidence-based interventions exist to prevent or manage HF, yet suboptimal care has been cited as a reason for poor HF-related outcomes in the United States,” Jackson, of the Centers for Disease Control and Prevention, et al. said. “For example, despite many HF hospitalizations being considered preventable, HF is the leading cause of hospitalization among older adults, and Medicare beneficiaries with HF have the highest readmission rate of any condition.”

The Hospital Readmissions Reduction Program (HRRP), made effective in 2012 through the Patient Protection and Affordable Care Act, alleviated some of that burden, the authors wrote, but we’re still not sure where HF burden stands today.

Jackson and her team analyzed data from 2006 to 2014, pulling information from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project National Inpatient Sample and National Vital Statistics System. They identified HF diagnoses and comorbidities using International Classification of Disease codes and estimated burden separately for emergency department (ED) visits, hospitalizations and mortality.

The authors found that in 2014, there were an estimated 1.07 million ED visits, 978,135 hospitalizations and 83,705 deaths in patients with primary HF. That same year saw 4.07 million ED visits, 3,.37 million hospitalizations and 230,963 deaths in patients with comorbid HF. Between 2006 and 2014, the total acute event rate for primary HF declined 16 percent while it increased by 15 percent for comorbid HF.

Jackson and coauthors reported HF-related mortality declined significantly between 2006 and 2009, but after that point it “did not change meaningfully.” By 2014, the estimated mean cost for hospitalizations with primary HF was $11,552, totaling an estimated $11 billion.

“Although national initiatives, such as the HRRP, may have helped continue progress in reducing HF readmissions, including among Medicare beneficiaries, as well as with broader spillover effects across the healthcare system, the rate of primary HF hospitalizations was already decreasing at the time of implementation in 2012,” the researchers wrote. “This observation is consistent with other studies that have reported declines in HF hospitalization before recently implemented policy changes.”

Hospitalizations and outcomes for HF could be improved with better treatment, Jackson et al. said, including implantable cardioverter-defibrillators, cardiac resynchronization therapy and left ventricular assist devices. Better adherence to guideline-recommended medications, like beta-blockers or angiotensin-converting enzyme inhibitors, might also help to drive down HF burden.

“The burden of heart failure in the United States in considerable,” the authors wrote. “Continued improvements in prevention, management, treatment and surveillance of HF are important, given the considerable health impact of HF, the aging U.S. population and rising healthcare costs.”