Temporal trends (2003–2018) of in-hospital and 30-day mortality in patients hospitalized with acute heart failure

Background

Limited temporal data on in-hospital mortality trends of patients hospitalized with acute heart failure (AHF) have been reported. We evaluated whether, in AHF hospitalized patients, the rate of in-hospital and 30-day mortality, and 30-day re-hospitalization for AHF have changed in the past 15 years.

Methods and results

We examined administrative data from the Lombardy region, Italy and analysed data of all adults hospitalized for AHF from 2003 to 2018. Patients were stratified according to the hospitalization period: 2003–2006; 2007–2010; 2011–2014; 2015–2018. Primary endpoint was the comparison of in-hospital mortality rates among periods. Secondary endpoints were 30-day mortality rates and temporal trends of re-hospitalization for AHF. During this period, 414,164 hospitalizations with a primary diagnosis of AHF were identified, involving 286,028 patients aged 18 and older. In-hospital and 30-day mortality in the entire cohort showed a progressive increase over time (from 6.7 % to 8.5 % and from 12.4 % to 14.5 %, respectively). Thirty-day re-hospitalization for AHF was 2 %, showing a progressive decrease over the years. However, patient’ age and complexity increased in the most recently hospitalized patients. After adjusting for major confounders, in-hospital and 30-day mortality risks were similar moving from one study period to the next (relative risk for trend 1.00 [95 % CI 0.99–1.01] and 1.00 [95 % CI 0.98–1.01], respectively), while that of 30-day AHF re-hospitalization decreased progressively (hazard ratio for trend 0.86 [95 % CI 0.84–0.88]).

Conclusions

In our study, the increasing age and complexity of patients largely accounted for the continued rise in early mortality observed in patients hospitalized with AHF.