The expanding national burden of heart failure in the United States: the influence of heart failure in women

Background Although some studies have shown that hospital admissions for heart failure doubled between 1973 and 1995, other data suggest that the heart failure hospitalization epidemic has stabilized in the United States. We sought to describe trends in heart failure hospitalizations over the past decade using data from the National Hospital Discharge Survey (NHDS). Methods The NHDS provides annual estimates of hospitalization discharges from a sample of hospitals in the United States. We combined the heart failure hospitalization frequencies with census estimates to calculate age and gender-specific annual hospitalization rates. Results Hospitalizations with a primary diagnosis of heart failure among adults (age ≥35) increased from 810,624 in 1990 to 989,500 in 1995 (annual increase 36,088, R2 = 0.816, P = .014), and to 1,088,349 in 1999 (annual increase 31,091, R2 = 0.780, P = .047). The age-adjusted hospitalization rate (per 1000 persons) increased from 7.186 in 1990 to 8.554 in 1999 for women (annual increase 0.14/year, R2 = 0.731, P = .002) and from 6.892 in 1990 to 7.372 in 1999 for men (annual increase 0.011/year, R2 = 0.008, P = 0.80). For women, the annual hospitalization rate increased from 1990 to 1999 in each age group (35–64, 65–74, 75–84, and ≥85), while the age-specific rates did not change in men. Conclusions Heart failure hospitalizations have continued to increase from 1990 to 1999. Although aging and growth of the US population contribute to this trend, the increases are substantially influenced by changes in hospitalization rates in women.