TEMPORAL TRENDS IN ACUTE DECOMPENSATED HEART FAILURE HOSPITALIZATIONS IN THE U.S., 1998-2011

Background: Trends for acute decompensated heart failure (ADHF) hospitalizations based on the primary discharge ICD codes have declined in the U.S. However, HF ICD codes are increasingly found in non-primary positions. Validation data are needed to estimate the frequency of ADHF hospitalizations. Methods: The ARIC Study conducts surveillance for hospitalized ADHF in four U.S. communities for age ≥ 55 years since 2005. Hospital records are sampled, abstracted, and classified as ADHF or not by an expert physician panel. Analyses were stratified on code groups (a) 428.xx in primary-position, (b) 428.xx in non-primary position, and (c) other sampled HF ICD code (398, 402, 404, 415, 416, 425, 518, 786) in any position. We calculated ADHF probability in each group overall (positive predictive value, PPV), and by using regression models. We estimated the nationwide trends of ADHF hospitalizations from the National Inpatient Sample (NIS), a 20% probability sample of U.S. community hospitals, by applying the calibration factors derived in the ARIC study. Results: In ARIC surveillance 42% of eligible hospitalizations (n=12,450 charts) validated as ADHF. NIS data included 9 million eligible hospitalizations during 1999-2010. The estimated numbers of US ADHF hospitalization in 2010 among Americans ≥ 55 years old was 1.8 (SE 0.02) million as compared to 0.8 (SE 0.002) million with 428.xx in the primary position ( Figure ). The estimated ADHF hospitalizations in the U.S. increased from 1.6 million in 1999 to 1.9 million in 2006, and then decreased to 1.8 million in 2010 (average annual increase of 1%, p-trend <0.01). Estimated ADHF based on regression models for each of the three code groups gave similar results. The temporal increase was steeper among men and in age category 55-64 years than older ages. Conclusions: Estimated frequency of ADHF hospitalizations by ARIC validation criteria is about two times higher than ICD 428 in primary position; with an overall increasing vs. declining trend over the last decade.

Download Full-text

Mortality rates are going down in clinical use of inotropics. Temporal trends for prognosis in acute decompensated heart failure (1992/1999–2005/ 2006)

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.06.011 ◽

2014 ◽

Vol 175 (3) ◽

pp. 584-586 ◽

Cited By ~ 1

Author(s):

Juliano N. Cardoso ◽

André Grossi ◽

Carlos H. Del Carlo ◽

Cristina Martins dos Reis ◽

Milena Curiati ◽

...

Keyword(s):

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Temporal Trends ◽

Decompensated Heart Failure ◽

Mortality Rates ◽

Clinical Use

Download Full-text

Temporal trends in clinical characteristics, treatments, and outcomes for heart failure hospitalizations, 2002 to 2004: findings from Acute Decompensated Heart Failure National Registry (ADHERE)

American Heart Journal ◽

10.1016/j.ahj.2007.03.012 ◽

2007 ◽

Vol 153 (6) ◽

pp. 1021-1028 ◽

Cited By ~ 259

Author(s):

Gregg C. Fonarow ◽

J. Thomas Heywood ◽

Paul A. Heidenreich ◽

Margarita Lopatin ◽

Clyde W. Yancy

Keyword(s):

Heart Failure ◽

Clinical Characteristics ◽

Acute Decompensated Heart Failure ◽

Temporal Trends ◽

Decompensated Heart Failure ◽

National Registry

Download Full-text

Comparison of management and outcomes of ED patients with acute decompensated heart failure between the Canadian and United States’ settings

CJEM ◽

10.1017/cem.2015.43 ◽

2015 ◽

Vol 18 (2) ◽

pp. 81-89 ◽

Cited By ~ 1

Author(s):

Anita Lai ◽

Elliott Tenpenny ◽

David Nestler ◽

Erik Hess ◽

Ian G. Stiell

Keyword(s):

United States ◽

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Admission Rate ◽

Decompensated Heart Failure ◽

The United States ◽

Health Records ◽

Male Sex ◽

Relapse Rates ◽

The U.S

AbstractIntroductionThe objective of this study was to compare the emergency department (ED) management and rate of admission of acute decompensated heart failure (ADHF) between two hospitals in Canada and the United States and to compare the outcomes of these patients.MethodsThis was a health records review of adults presenting with ADHF to two EDs in Canada and the United States between January 1 and April 30, 2010. Outcome measures were admission to the hospital, myocardial infarction (MI), and death or relapse rates to the ED. Data were analysed using descriptive, univariate and multivariate analyses.ResultsIn total, 394 cases were reviewed and 73 were excluded. Comparing 156 Canadian to 165 U.S. patients, respectively, mean age was 76.0 and 75.8 years; male sex was 54.5% and 52.1%. Canadian and U.S. ED treatments were noninvasive ventilation 7.7% v. 12.8% (p=0.13); IV diuretics 77.6% v. 36.0% (p<0.001); IV nitrates 4.5% v. 6.7% (p=0.39). There were significant differences in rate of admission (50.6% v. 95.2%, p<0.001) and length of stay in ED (6.7 v. 3.0 hours, p<0.001). Proportion of Canadian and U.S. patients who died within 30 days of the ED visit was 5.1% v. 9.7% (p=0.12); relapsed to the ED within 30 days was 20.8% v. 17.5% (p=0.5); and had MI within 30 days was 2.0% v. 1.9% (p=1.0).ConclusionsThe U.S. and Canadian centres saw ADHF patients with similar characteristics. Although the U.S. site had almost double the admission rate, the outcomes were similar between the sites, which question the necessity of routine admission for patients with ADHF.

Download Full-text

Mortality is going down even in patients treated with inotropics. Temporal trends in prognosis in acute decompensated heart failure 1992-1999/2005-2006

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(08)60536-6 ◽

2008 ◽

Vol 7 ◽

pp. 193-193

Author(s):

A PEREIRABARRETTO ◽

C DELCARLO ◽

J CARDOSO ◽

M OCHIAI ◽

M OLIVEIRAJR ◽

...

Keyword(s):

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Temporal Trends ◽

Decompensated Heart Failure

Download Full-text

Abstract P319: Racial Differences and Temporal Trends in Obesity Among Patients Hospitalized With Acute Decompensated Heart Failure With Preserved Ejection Fraction: The ARIC Study Community Surveillance

Circulation ◽

10.1161/circ.141.suppl_1.p319 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Melissa C Caughey ◽

Muthiah Vaduganathan ◽

Sameer Arora ◽

Arman Qamar ◽

Robert J Mentz ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Racial Differences ◽

Acute Decompensated Heart Failure ◽

Temporal Trends ◽

Decompensated Heart Failure ◽

Obesity Paradox ◽

Black Patients ◽

Aric Study ◽

White Patients

Introduction: Obesity is disproportionately prevalent in black populations and strongly associated with heart failure with preserved ejection fraction (HFpEF). An “obesity paradox” or lower mortality risk with obesity, has been reported in HFpEF populations. Whether racial differences exist in the temporal trends and outcomes of obesity is uncertain. Methods: Hospitalizations for acute decompensated heart failure (ADHF) were sampled from 2005-2014 by the ARIC Study Community Surveillance and classified by physician review. BMI was calculated using the admission height and weight. Associations between obesity and 1-year all-cause mortality were analyzed with multivariable Cox regression. Results: There were 10,147 weighted hospitalizations for ADHF with ejection fraction ≥50% (64% female, 74% white). Overall, black patients had a higher mean BMI than white patients (34 vs. 30 kg/m 2 ; P <0.0001), and a greater prevalence of obesity (56% vs. 43%; P <0.0001). Mean BMI and obesity steadily increased from 2005-2014 for white patients (Trends: P = 0.003 and P = 0.002) while remaining stable for black patients. Within BMI groups (18.5-24, 25-30, 30-35, 35-40, and ≥40 kg/m 2 ) a U-shaped mortality risk was observed, with the lowest risk among patients with a BMI of 30-35 kg/m 2 ( Figure ). When defining obesity by a BMI cutpoint ≥30 kg/m 2 , the “obesity paradox” was apparent in 2005-2009 for white obese vs. non-obese patients (HR = 0.58, 95% CI: 0.38 - 0.80), but attenuated by 2010-2014 (HR = 1.11; 95% CI: 0.80 - 1.48); P for interaction =0.006. Among black patients, there was no survival benefit for a BMI ≥30 kg/m 2 in 2005-2009 (HR = 1.15; 95% CI; 0.65 - 2.02) or 2010-2014 (HR = 1.06; 95% CI: 0.68 - 1.66). Conclusion: In this decade-long community surveillance of HFpEF patients hospitalized with ADHF, obesity and mean BMI were stable for black patients but steadily increased for white patients. A BMI ≥30 kg/m 2 was initially associated with better survival among white patients but the association dissipated as obesity and mean BMI increased over time.

Download Full-text