While hospitals worldwide battle a relentless tide of over 17 million heart failure admissions annually, the United States alone recorded a staggering 1.15 million such hospitalizations in a single year, revealing a complex and costly public health crisis shaped by startling disparities in who is most affected.
Key Takeaways
- In the United States, there were 1,153,107 hospitalizations for heart failure as primary diagnosis in 2020, marking a 14.5% increase from 2019.
- The age-adjusted hospitalization rate for heart failure in the US decreased from 284 per 100,000 in 2000 to 198 per 100,000 in 2019.
- Among Medicare beneficiaries aged 65+, heart failure hospitalization rates were 2,945 per 100,000 person-years in 2018.
- Among US adults 18-64, heart failure hospitalization rate was 85 per 100,000 in 2019.
- 52% of heart failure hospitalizations in US were women in 2020.
- Mean age of heart failure hospitalization patients in US: 72 years in 2020.
- 75% of US heart failure hospitalizations had hypertension as comorbidity in 2020.
- Diabetes present in 42% of US HF hospitalization patients in 2020.
- Atrial fibrillation comorbid in 35% of heart failure hospitalizations US 2020.
- 68% of US heart failure hospitalizations involved IV loop diuretics in 2020.
- Beta-blockers prescribed at discharge in 92% of HF hospitalizations US 2018.
- ACE inhibitors/ARBs used in 75% of HFrEF patients hospitalized US 2020.
- Inpatient mortality for heart failure hospitalizations in US was 3.2% in 2020.
- 30-day all-cause readmission rate for HF: 21.4% in Medicare beneficiaries 2018.
- 1-year mortality post-HF hospitalization: 30% in US adults over 65.
Heart failure hospitalizations remain high worldwide with significant regional and racial disparities.
Demographic Characteristics
- Among US adults 18-64, heart failure hospitalization rate was 85 per 100,000 in 2019.
- 52% of heart failure hospitalizations in US were women in 2020.
- Mean age of heart failure hospitalization patients in US: 72 years in 2020.
- Black patients comprised 22% of US heart failure hospitalizations despite being 13% of population in 2020.
- Hispanics represented 12% of heart failure hospitalizations in US 2020.
- In Medicare data, 55% of HF hospitalizations were in patients over 80 years old in 2018.
- US rural heart failure patients: 20% of hospitalizations, higher comorbidity burden.
- Women had longer HF hospital stays (6.1 days) than men (5.0 days) in US 2020.
- Among US HF hospitalizations, 15% were under age 65 in 2020.
- Native Americans had HF hospitalization rates 1.8 times higher than Whites in 2017.
- In England, 48% of HF patients hospitalized were female, mean age 77 years in 2014.
- US Veterans: 92% male in HF hospitalizations, mean age 74 in 2019.
- Asian Americans: 4% of US HF hospitalizations in 2020, lower rate than expected.
- Patients with Medicaid insurance: 18% of HF hospitalizations in US 2020.
- In Canada, 51% female HF hospitalizations, Indigenous peoples 2x rate in 2019.
- US South region: 38% of national HF hospitalizations in 2020.
- Heart failure hospitalizations peak in winter months, 15% higher Dec-Feb in US.
- In Australia, 49% female HF patients hospitalized, mean age 78 in 2019.
- US uninsured patients: 6% of HF hospitalizations in 2020.
- Elderly women (>85): 25% of female HF hospitalizations in Medicare 2018.
- In Japan, 55% male HF hospitalizations, mean age 80 in 2018.
- US Northeast: lowest regional HF hospitalization share at 18% in 2020.
- Pediatric HF hospitalizations: 60% male in US 2014.
- Heart failure with reduced EF more common in men (55%) vs preserved in women (60%).
- In EU, 46% female HF hospitalizations, higher in elderly cohorts.
- US private insurance: 25% of HF hospitalizations in 2020.
Demographic Characteristics Interpretation
Heart failure appears to have a depressingly clear target: it stalks the elderly, preys on the disadvantaged, burdens rural communities, spikes in the cold, and shows a particular cruelty in making women's hospital stays significantly longer even while they constitute the majority of its victims.
Incidence and Hospitalization Rates
- In the United States, there were 1,153,107 hospitalizations for heart failure as primary diagnosis in 2020, marking a 14.5% increase from 2019.
- The age-adjusted hospitalization rate for heart failure in the US decreased from 284 per 100,000 in 2000 to 198 per 100,000 in 2019.
- Among Medicare beneficiaries aged 65+, heart failure hospitalization rates were 2,945 per 100,000 person-years in 2018.
- In England, heart failure hospitalizations rose by 23% from 2002 to 2014, reaching 92,800 episodes annually.
- US national heart failure hospitalization volume was 992,978 in 2018, with a slight decline from prior years.
- Heart failure accounts for over 1 million hospitalizations yearly in the US, with rates highest in the South at 250 per 100,000.
- From 2010-2019, heart failure hospitalization rates in Canada decreased by 12% to 180 per 100,000.
- In Australia, acute heart failure hospitalizations numbered 45,000 in 2018-19, rate of 177 per 100,000.
- EU countries reported 1.2 million heart failure hospitalizations in 2019, averaging 240 per 100,000 population.
- In Japan, heart failure hospitalizations increased 2.5-fold from 2000 to 2018, reaching 250,000 annually.
- US Black adults had heart failure hospitalization rates 2.4 times higher than Whites in 2017 (450 vs 185 per 100,000).
- Rural US areas saw heart failure hospitalization rates of 220 per 100,000 vs 170 in urban in 2019.
- During COVID-19, US heart failure hospitalizations dropped 35% in early 2020 to 65,000 monthly.
- In 2021, heart failure hospitalizations in New York State totaled 45,200, rate of 225 per 100,000.
- Veterans Affairs data showed 120,000 heart failure hospitalizations in 2019, rate 1,200 per 100,000 beneficiaries.
- Heart failure hospitalization rates in US men were 210 per 100,000 vs 190 in women in 2020.
- In Scotland, heart failure admissions fell 15% from 2010-2020 to 12,500 yearly.
- Brazil reported 1.1 million heart failure hospitalizations from 2013-2019, averaging 170 per 100,000.
- In 2016, US hospitalization rate for heart failure with preserved ejection fraction was 110 per 100,000.
- Global estimate: 17 million heart failure hospitalizations annually as of 2022.
- In California, 2020 heart failure hospitalizations: 78,500, rate 200 per 100,000 population.
- Heart failure hospitalizations in US emergency departments: 2.5 million visits in 2019.
- From 2005-2014, US pediatric heart failure hospitalizations increased 25% to 14,000 annually.
- In France, 180,000 heart failure hospitalizations in 2019, rate 270 per 100,000.
- US hospital charges for heart failure averaged $13,500 per stay in 2020.
- Heart failure hospitalization length of stay averaged 5.5 days in US 2020.
- In Germany, 380,000 heart failure hospital cases in 2019, rate 450 per 100,000.
- South Korea heart failure hospitalizations: 110,000 in 2018, up 40% since 2008.
- In Texas, 2021 heart failure hospitalizations: 92,000, highest state rate at 310 per 100,000.
- UK heart failure emergency admissions: 75% of all HF hospitalizations in 2020.
Incidence and Hospitalization Rates Interpretation
Our collective cardiovascular struggle reveals a paradox: while we're treating the disease better on paper (evident in falling age-adjusted rates), our aging, fractured, and burdened bodies are filling hospitals in record numbers, exposing profound geographic, racial, and socioeconomic disparities in the blunt reality of who gets sickest.
Outcomes, Mortality, and Readmissions
- Inpatient mortality for heart failure hospitalizations in US was 3.2% in 2020.
- 30-day all-cause readmission rate for HF: 21.4% in Medicare beneficiaries 2018.
- 1-year mortality post-HF hospitalization: 30% in US adults over 65.
- HF hospitalization mortality higher in Blacks (4.1%) vs Whites (3.0%) US 2020.
- 90-day readmission rate for HF: 33% in US national data 2019.
- In-hospital mortality for acute decompensated HF: 4.5% in EU 2019.
- Medicare HF readmission penalty affected 58% of hospitals in 2020.
- Post-discharge mortality within 6 months: 25% for HFpEF patients US.
- 30-day mortality post-HF hospitalization: 10.5% in patients over 85 US.
- HF readmissions account for 25% of total Medicare HF spending.
- In VA system, HF 30-day readmission rate: 19% in 2019.
- 1-year readmission rate post-HF discharge: 60% in US elderly.
- Mortality during index HF hospitalization doubled during COVID peaks to 6%.
- England HF in-hospital mortality: 10.5% in 2014.
- 30-day HF readmission lowest in Northeast US hospitals at 18%.
- Post-HF hospitalization survival at 5 years: 25% in US cohorts.
- Rural hospitals HF readmission rate: 23% vs urban 20% US 2019.
- Inotropes associated with 15% in-hospital mortality in HF US 2020.
- HFpEF 30-day readmission: 22% vs HFrEF 20% US 2019.
- Japan HF hospitalization mortality: 5.8% in 2018.
- 60-day readmission for HF with mechanical ventilation: 35% US.
- Overall HF patient survival post-hospitalization: 50% at 3 years US.
- CMS HF readmission measure: national average 21.5% FY2023.
- Mortality higher in HF with renal failure: 8% in-hospital US 2020.
- Australia HF 28-day readmission: 18% in 2019.
- Pediatric HF in-hospital mortality: 7% US 2014.
- HF readmission driven by 40% same cause (HF) within 30 days US.
Outcomes, Mortality, and Readmissions Interpretation
Even surviving the initial hospital stay for heart failure often feels like a cruel game of statistical roulette, with nearly a one in three chance of not seeing next year and alarmingly high odds of boomeranging right back into a hospital bed, revealing a healthcare system struggling to provide consistently safe and durable care.
Risk Factors and Comorbidities
- 75% of US heart failure hospitalizations had hypertension as comorbidity in 2020.
- Diabetes present in 42% of US HF hospitalization patients in 2020.
- Atrial fibrillation comorbid in 35% of heart failure hospitalizations US 2020.
- Chronic kidney disease in 38% of US HF patients hospitalized in 2020.
- Coronary artery disease history in 52% of HF hospitalizations in US 2020.
- Obesity (BMI>30) in 33% of heart failure hospitalization cases US 2020.
- COPD comorbid with HF in 28% of US hospitalizations 2020.
- Anemia present in 25% of heart failure hospitalized patients US 2020.
- Smoking history in 22% of HF hospitalization records US 2020.
- Hyperlipidemia in 48% of US heart failure hospitalizations 2020.
- Alcohol abuse disorder in 5% of HF patients hospitalized US 2020.
- Depression diagnosed in 18% of heart failure hospitalizations US 2020.
- Valvular heart disease in 15% of US HF hospitalizations 2020.
- Sleep apnea comorbid in 12% of heart failure cases US 2020.
- Cerebrovascular disease in 14% of HF hospitalized patients US 2020.
- Peripheral vascular disease in 16% of US heart failure hospitalizations 2020.
- Cancer history in 10% of HF patients during hospitalization US 2020.
- Drug abuse in 4% of heart failure hospitalization diagnoses US 2020.
- Dementia in 12% of elderly HF hospitalizations Medicare 2018.
- Hypothyroidism in 11% of US HF patients hospitalized 2020.
- Liver disease in 6% of heart failure hospitalizations US 2020.
- HIV/AIDS in 0.5% of HF hospitalizations US 2020.
- Rheumatoid arthritis/osteoarthritis in 8% of US HF cases 2020.
- Fluid/electrolyte disorders in 30% of heart failure hospitalizations US 2020.
- In England, 40% of HF hospitalizations had ischemic heart disease comorbidity in 2014.
- Diabetes with complications in 15% of US HF hospitalizations 2020.
- Pulmonary hypertension in 7% of heart failure patients US 2020.
Risk Factors and Comorbidities Interpretation
While we were busy blaming the heart for its failure, a staggering 75% of these patients were also wrestling with hypertension, and over half had coronary artery disease, proving the real culprit is often a whole gang of chronic conditions conspiring together.
Treatment Patterns
- 68% of US heart failure hospitalizations involved IV loop diuretics in 2020.
- Beta-blockers prescribed at discharge in 92% of HF hospitalizations US 2018.
- ACE inhibitors/ARBs used in 75% of HFrEF patients hospitalized US 2020.
- Mineralocorticoid receptor antagonists in 32% of eligible HF patients at discharge 2018.
- SGLT2 inhibitors prescribed in only 2% of HF hospitalizations pre-2022.
- ICD implantation during HF hospitalization in 3% of US cases 2020.
- Cardiac catheterization performed in 18% of HF admissions US 2020.
- Mechanical ventilation used in 8% of heart failure hospitalizations US 2020.
- Dialysis initiated or continued in 10% of HF patients with CKD US 2020.
- BNP/NT-proBNP testing in 85% of US HF hospitalizations 2020.
- Echocardiography during stay in 70% of heart failure hospitalizations US 2020.
- IV inotropes (dobutamine/milrinone) in 5% of acute HF cases US 2020.
- Ultrafiltration therapy in 1% of volume-overloaded HF hospitalizations US 2020.
- Palliative care consult in 15% of advanced HF hospitalizations US 2020.
- Sacubitril/valsartan prescribed at discharge in 12% of HFrEF patients 2020.
- CRT device placement in 2% of HF hospitalizations with wide QRS US 2020.
- Coronary revascularization during HF admission in 7% US 2020.
- Oxygen therapy administered in 60% of heart failure hospitalizations US 2020.
- Statin therapy at discharge in 65% of HF patients with CAD US 2020.
- Aspirin prescribed in 55% of ischemic HF hospitalizations US 2020.
- Vericiguat use in <1% of worsening chronic HF hospitalizations pre-2022.
- Telemonitoring setup at discharge in 5% of high-risk HF patients US 2019.
- IV iron for iron deficiency in 4% of HF hospitalizations US 2020.
- Cardiac rehab referral in 20% of eligible HF hospitalizations US 2020.
- Loop diuretic dose averaged 80mg furosemide equivalent daily in acute HF US.
- Inotropes used more in Black patients (7%) vs Whites (4%) in HF admissions.
- ARNI initiation increased to 25% in HFrEF hospitalizations by 2023.
- SGLT2i post-hospitalization rose to 35% in eligible patients 2023.
Treatment Patterns Interpretation
The data paints a picture of American heart failure care as a well-practiced but stubbornly traditional band, dutifully hitting the old standards like diuretics and beta-blockers with gusto while largely ignoring the exciting new members of the ensemble like SGLT2 inhibitors and comprehensive palliative care, suggesting our treatment playlist is in serious need of an update.
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