Hospitalization Rates for Younger Patients With HF Increased Over a 12-Year Span

 People younger than 65 years had an increased rate of hospitalization for heart failure (HF) between 2010 and 2022, whereas the rate for older individuals declined, according to a new study.

This pattern may reflect improved treatment and management in older adults, alongside a rising burden of cardiometabolic risk factors such as obesity, diabetes, and hypertension in younger populations, said senior author Boback Ziaeian, MD, PhD, cardiologist and outcomes researcher at the David Geffen School of Medicine at the University of California, Los Angeles.

Boback Ziaeian, MD, PhD

The analysis included more than 14 million records of inpatient treatment for HF, divided into two age-standardized groups of younger and older patients. The samples were further stratified by demographic data to assess the rates of HF hospitalizations over the time span.

“What stood out was the clear divergence by age group, which can be obscured when only overall rates are examined,” Ziaeian said. “While overall heart failure care has improved over time, these findings highlight that younger adults may be experiencing a growing disease burden.”

Trends Before and During COVID

The end of the study period coincided with the emergence of the COVID pandemic, which probably had a substantial impact on the observed trends, Ziaeian said. People delaying care or avoiding healthcare settings and hospitals’ higher thresholds for admission probably led to fewer recorded HF hospitalizations.

“In addition, COVID-related morbidity and mortality, especially among older adults with cardiovascular disease, may have altered the underlying at-risk population, making late-period trend interpretation more complex,” he said.

HF is the leading cause of hospitalization for cardiovascular conditions and the third most expensive condition for inpatient care in the US, with a high risk for readmissions.

“Our goal was to determine whether overall improvements in heart failure outcomes are occurring uniformly or whether they differ across populations,” Ziaeian said. The study was published online in JACC: Heart Failure.

Using de-identified health records in the public National Inpatient Sample database, researchers located 14,287,733 hospitalizations for HF. The overall trend in hospitalizations per 100,000 people decreased slightly from 406 in 2010 to 395 in 2022 (P = .002). In-hospital mortality did not improve from 2010 to 2022 and trended upward significantly in 2020 (P = .001).

Among patients younger than 65 years, hospitalization rates rose from 124 per 100,000 in 2010 to 161 in 2022, an average annual change of 2.2% (95% CI, 1.6-2.8; P < .001). Among those aged 65 years or older, hospitalization rate decreased from 1775 to 1525 over the same period, an average annual change of -1.2% (95% CI, -2.8 to 0.9; P = .15).

Non-Hispanic Black adults showed the highest rate of HF hospitalization, possibly due to a higher burden of cardiometabolic conditions and structural and socioeconomic barriers to care, researchers said. Hospitalization rates declined in rural hospitals compared with those in urban areas, from 249 to 176 per 100,000 people, which the authors suggest could be partially explained by widespread rural hospital closures, changes in rural demographics, and the transfer of patients to urban hospitals.

Preventing HF Earlier

“It will be interesting to see what happens after 2022,” Abdul Mannan Khan Minhas, MD, cardiovascular disease fellow at Baylor College of Medicine in Houston, said, noting that other databases show HF modalities increasing despite the drop in overall HF hospitalizations during the pandemic. Minhas was not involved in the current study.

Abdul Mannan Khan Minhas, MD

The results suggest clinicians could help younger patients control comorbidities earlier, potentially by modifying HF risk factors and administering guideline-directed therapies, Minhas said.

“More broadly, these findings support shifting emphasis toward prevention and chronic disease management strategies that reduce the future burden of hospitalization rather than relying primarily on inpatient care,” Ziaeian said.

Ziaeian reported being supported by the National Institutes of Health (NIH) or National Institute on Minority Health and Health Disparities (#P50-MD017366 UC END-DISPARITIES Pilot Award) and the NIH National Center for Advancing Translational Sciences grant (UCI ICTS UL1TR000153). All other authors reported having no relevant financial relationships. Minhas reported having no disclosures.

https://www.medscape.com/viewarticle/hospitalization-rates-younger-patients-hf-increased-over-12-2026a1000e6w