Heart failure hospitalization incidence decreased from 790 to 564 per 100,000 person-years between 2005 and 2023, with only 55% of patients starting optimal medical therapy within 90 days.
What are the trends in heart failure hospitalizations and the determinants of initiating optimal medical therapy post-discharge?
Heart failure hospitalization incidence has decreased over time, but optimal medical therapy is only initiated in about half of patients post-discharge, highlighting a gap in care especially for older patients and those with prior cardiovascular hospitalizations.
We evaluated trends in prevalence and incidence of heart failure (HF) hospitalizations in Lombardy, and the characteristics of patients starting optimal medical treatment (O-HF-T: almost three among: diuretics, mineralocorticoid receptor antagonist, beta-blockers, ACE-inhibitors, Angiotensin Receptor Blockers). We analysed hospital discharge data with HF-related ICD9-CM recorded in the regional healthcare service from 2000 to 2023. Age-gender standardized HF prevalence and incidence rates were calculated from 2005 to 2023. Determinants of starting O-HF-T, in the three months after discharge, were investigated by Log-Binomial model. HF incidence rates decreased from 790 per 100,000 years-person in 2005 to 564 per 100,000 in 2023; males had higher rates. Standardized prevalence rate increased until 2010, followed by a decrement peaking in the SARS-CoV2 pandemic year 2020. We investigated starting of O-HF-T, and its determinants, in a cohort of incident HF hospitalized patients from January 2010 to September 2019 to avoid the pandemic period (54022 patients, mean age 70 years, 60% males; 55% started O-HF-T within 90-days after discharge. The likelihood of starting O-HF-T was higher in younger males and in patients already treated with lipid-lowering, antidiabetic and antihypertensive drugs before the HF hospitalization. The likelihood of receiving O-HF-T decreased with age, in patients treated with antidepressants and in those with previous CV hospitalizations. The reduction of hospitalisations after 2010 can be explained by a combination of improved disease prevention and better care. Optimal medical treatment was achieved in about half of patients, mainly in younger males.
Malfatto et al. (2026) studied this question. Heart failure hospitalization incidence decreased from 790 to 564 per 100,000 person-years between 2005 and 2023, with only 55% of patients starting optimal medical therapy within 90 days.