Temporal trends (2003-2018) of in-hospital and 30-day mortality in patients hospitalized with acute heart failure in lombardy

Abstract Introduction Limited and controversial temporal trend of in–hospital mortality of patients hospitalized with acute heart failure (AHF) have been reported. We evaluated whether, in AHF hospitalized patients, the rate of in–hospital and 30–day mortality, and 30–day re–hospitalization for AHF changed in the last 15 years. Methods We examined administrative data from Lombardy (∼10.000.000 inhabitants), Italy. We analyzed data of all adults hospitalized for AHF from 2003 to 2018 in Lombardy. Patients were stratified according to hospitalization period: 2003–2006; 2007–2010; 2011–2014; 2015–2018. The primary study endpoint was the comparison among periods of in–hospital mortality, while secondary endpoints were 30–day mortality and re–hospitalization for AHF temporal trends. Results During the study period, 414,164 patients were hospitalized with a primary diagnosis of AHF. The in–hospital and 30–day mortality in the entire cohort showed a progressive increase over time (from 6.7% to 8.5% and from 12.4% to 14.5%, respectively). Thirty–day re–hospitalization for AHF was 2% showing a progressive decrease across years. However, patient’ complexity, as inferable from number of comorbidities, increased in most recently hospitalized patients. After matching for age, gender, and admission ward, the study population included 78,884 patients in each study period. In the matched population, after further adjustment for major comorbidities, the risk of in–hospital and 30–day mortality and of the 30–day risk of AHF re–hospitalization progressively decreased from one period to the following one by 1% (95% confidence interval [CI] 0%–2%), 2% (1%–3%) and 10% (8%–12%), respectively. Conclusions In our study, the greater patients’ complexity largely accounted for the continuing rise in early mortality observed in patients hospitalized with AHF. This work was partly financed by the Italian Ministry of Health and the Lombardia Region (Grant NET–2016–02364191; EASY–NET).