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National and Regional Trends in Heart Failure Hospitalization and Mortality Rates for Medicare Beneficiaries, 1998-2008.
Chen, Jersey MD, MPH; Normand, Sharon-Lise T. PhD; Wang, Yun PhD; Krumholz, Harlan M. MD, SM
[Article] JAMA. 306(15):1669-1678, October 19, 2011.

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Context: It is not known whether recent declines in ischemic heart disease and its risk factors have been accompanied by declines in heart failure (HF) hospitalization and mortality.

Objective: To examine changes in HF hospitalization rate and 1-year mortality rate in the United States, nationally and by state or territory.

Design, Setting, and Participants: From acute care hospitals in the United States and Puerto Rico, 55 097 390 fee-for-service Medicare beneficiaries hospitalized between 1998 and 2008 with a principal discharge diagnosis code for HF.

Main Outcome Measures: Changes in patient demographics and comorbidities, HF hospitalization rates, and 1-year mortality rates.

Results: The HF hospitalization rate adjusted for age, sex, and race declined from 2845 per 100 000 person-years in 1998 to 2007 per 100 000 person-years in 2008 (P < .001), a relative decline of 29.5%. Age-adjusted HF hospitalization rates declined over the study period for all race-sex categories. Black men had the lowest rate of decline (4142 to 3201 per 100 000 person-years) among all race-sex categories, which persisted after adjusting for age (incidence rate ratio, 0.81; 95% CI, 0.79-0.84). Heart failure hospitalization rates declined significantly faster than the national mean in 16 states and significantly slower in 3 states. Risk-adjusted 1-year mortality decreased from 31.7% in 1999 to 29.6% in 2008 (P < .001), a relative decline of 6.6%. One-year mortality rates declined significantly in 4 states but increased in 5 states.

Conclusions: The overall HF hospitalization rate declined substantially from 1998 to 2008 but at a lower rate for black men. The overall 1-year mortality rate declined slightly over the past decade but remains high. Changes in HF hospitalization and 1-year mortality rates were uneven across states.