Significant and constant increase in hospitalization due to heart failure in Spain over 15 year period

Background: To examine trends in the incidence, characteristics, and in-hospital outcomes of heart failure (HF) hospitalizations from 2001 to 2015 in Spain. Methods: Using the Spanish National Hospital Discharge Database (SNHDD) we selected admissions with a primary or secondary diagnosis of HF. The primary end points were trends in the incidence of hospitalizations and in-hospital mortality (IHM). Trends with primary and secondary diagnosis of HF were evaluated separately. Results: The incidence of HF coding increased significantly from 466.16 cases per 100,000 inhabitants in 2001-03 to 780.4 in 2013-15 (p <.001). Age increased over time (76.33 +/- 10.92 years in 2001-03 vs. 79.4 +/- 10.78 years in 2013-15; p <.001). We found a decrease in the percentage of women over the study period (53.07% vs. 52%; p <.001). We detected a significant increase in comorbidity according to the Charlson Comorbidity Index over time (mean 2.17 +/- 0.98 in 2001-03 vs. 2.46 +/- 1.04 in 2013-15). The most common associated comorbidities were atrial fibrillation (42.23%), hypertension (38.87%) and type 2 diabetes (34.3%). For the total time period, IHM was 12.79%. IHM decreased significantly over time from 13.47% in 2001-03 to 12.30% in 2013-15. Patients with HF coded as a secondary diagnosis have 66% higher risk of dying in the hospital that those with HF coded as a primary diagnosis. Conclusions: This research shows an increase of hospitalizations due to HF in Spain, particularly in patients with HF as a secondary diagnosis. Advance age and comorbidity in acute HF has increased in the recent years. However, IHM is decreasing while readmissions remain stable.