National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity

Abstract

Background National heart failure (HF) hospitalization rates have not been appropriately age-standardized by sex or race/ethnicity. Reporting hospital utilization trends by subgroup is important for monitoring population health and developing interventions to eliminate disparities. Methods and Results The National Inpatient Sample (NIS) was used to estimate the crude and age-standardized rates of HF hospitalization between 2002 and 2013 by sex and race/ethnicity. Direct standardization was used to age-standardize rates to the 2000 U.S. standard population. Relative differences between subgroups were reported. The national age-adjusted HF hospitalization rate decreased 30.8% from 526.86 to 364.66 per 100,000 between 2002 and 2013. While hospitalizations decreased for all subgroups, the ratio of the age-standardized rate for males compared to females increased from 20% greater to 39% (p-for-trend=0.002) between 2002 and 2013. Black males had a rate that was 229% (p-for-trend=0.141) and black females 240% (p-for-trend=0.725) with reference to whites in 2013 with no significant change between 2002 and 2013. Hispanic males had a rate that was 32% greater in 2002 and the difference narrowed to 4% (p-for-trend=0.047) greater in 2013 relative to whites. For Hispanic females the rate was 55% greater in 2002 and narrowed to 8% greater (p-for-trend=0.004) in 2013 relative to whites. Asian/Pacific Islander (PI) males had a 27% lower rate in 2002 that improved to 43% (p-for-trend=0.040) lower in 2013 relative to whites. For Asian/PI females the hospitalization rate was 24% lower in 2002 and improved to 43% (p-for-trend=0.021) lower in 2013 relative to whites. Conclusions National HF hospitalization rates have decreased steadily over the recent decade. Disparities in HF burden and hospital utilization by sex and race/ethnicity persist. Significant population health interventions are needed to reduce the HF hospitalization burden among blacks. The evaluation of factors explaining the improvements in the HF hospitalization rates among Hispanics and Asian/PI are needed.

Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003–2014

“…Trend analysis suggests that, from 2003 to 2014, inflation‐adjusted inpatient medical expenditures for patients with hypertension actually declined, while outpatient and home‐based expenditures increased somewhat. This may reflect decreases in hospitalization rates, shorter lengths of stay, fewer procedures such as cardiac catheterizations, or decreased readmissions for complications, as has been shown for other chronic medical disease states in recent years including for heart failure . The trend may also signal the positive impacts associated with improvements in hypertension diagnosis, treatment, and control in recent decades, marking a shift towards preventative rather than reactive care.…”

A novel nomogram to predict all‐cause readmission or death risk in Chinese elderly patients with heart failure

“…Presently, the readmission or death risk prediction models established in previous studies for patients with HF have modest predictive ability. Although medical complex of elderly patients with HF would explain the poor readmission or death risk prediction, overlooking the important risk factors for readmission and death including the heterogeneity between races and noncardiac co‐morbidities was more considerable 8,12,21 . The HF population in China differs from that in Western countries, including notably more stroke and a lower BMI, 1,9,22 making data derived from Western populations likely to be not applicable.…”

“…However, it is suboptimal using a one‐size‐fits‐all approach to predict the risk of readmission or death for all patients with HF. First, racial and ethnic disparities have been indicated among patients with HF in some prior studies 8 . HF risk factors vary substantially across world regions, such as China populations having more stroke and lower body mass index (BMI) than have Western populations 1,9,10 .…”

Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan

“…Accordingly, patients admitted to hospital are often sicker and more likely to die. The National Heart Failure Audit for England & Wales reported an in‐patient mortality of 9.4% for 32 991 HHF patients in 2013–2014 (although <3.0% if aged <65 years), which is a much higher mortality than that reported in the USA (3.1% in 2010–2013) or Japan (6.4% in 2007–2011) . Until an international model to assess prognosis is developed, it may be impossible to determine whether poor outcome for HHF in a country reflects a high or low quality of care.…”