Though fewer American adults were hospitalised with heart failure during the
last decade, hospitalisation rates among heart failure patients under age 55 saw
the least change, according to a new study.
Based on billing data for almost 1.7 million US heart failure patients,
researchers found that the number of hospital stays for the condition fell
overall by about 27% between 2001 and 2009.
"There have been significant reductions in the absolute number of heart
failure hospitalisations. It's just the speed is not the same among the younger
patients," said Dr Jersey Chen, the study's lead author from Kaiser Permanente's
Mid-Atlantic Permanente Research Institute in Rockville, Maryland.
Previous research has shown that the number of hospital stays for heart
failure - when the heart cannot pump enough blood to the body - dropped by
nearly a third between 1998 and 2008 for patients covered by Medicare, the
government insurance program for people over 65.
But the causes of heart failure often differ between younger and older
patients, Chen and his colleagues write in the Journal of the American College
of Cardiology, and they were unsure whether there had been a comparable drop in
hospital stays among younger patients.
What the study found
For the new study, the researchers used a database of billing records for
Americans 18 years old and older.
Between 2001 and 2009, hospitalisations for heart failure fell from 633
hospital stays per 100 000 people to 463 stays per 100 000.
Adults 65 years old and older saw the greatest reductions in hospital stays -
a drop of about 37% over the nine years. That compared to a decrease of just 13%
among patients 18 to 44 years old and 16% among those between 45 and
The researchers also found that younger heart failure patients showed little
reduction in how long they spent in the hospital, or how many of them died
within 30 days of admission.
Length of stay in the hospital, on average, fell from about 5.6 days in 2001
to 5.3 days in 2009. But the change was almost entirely among patients over age
65. Deaths within 30 days of entering the hospital fell by about 8% among adults
younger than 45 over the nine-year period, compared to a drop of 22 percent for
patients 45 to 54 years old and a drop of 36% for patients between 55 and
Chen said "the jury is still out" on why younger patients haven't seen the
same reductions in heart failure hospitalisations and deaths in the hospital,
but it's an area of active research.
Management of risk factors
He said that it could be that management of risk factors for heart failure in
older adults - such as high blood pressure and heart disease - is easier to
control, compared to the typical causes of the condition in younger
Birth defects in the heart, for example, would be harder to avoid than high
blood pressure, he said."I think we need to figure out why, what is causing the
heart failure in the younger patients, more precisely than what we can get from
this administrative data," Chen added.
The differences between older and younger heart failure patients may also be
explained by differences in hospital care and insurance, noted Dr Adrian
Hernandez, an associate professor of medicine and cardiology at the Duke
University School of Medicine in Durham, North Carolina.
"While (the authors) speculate some of this may be greater risk factor
control, that doesn't seem like something that would have much impact on length
of stay," said Hernandez, who wasn't involved in the new research.
Hernandez said there could be differences between a younger patient and an
older adult in what an insurer is willing to pay for.
"(The findings are) good news for certain patient groups that have been able
to get out of the hospital faster and on a better course, but there is more work
to be done to make sure all patients have that experience," Hernandez said.