Abstract P024: Temporal Trends in Hospitalizations for Acute Decompensated Heart Failure in the U.S.: Calibration using The Atherosclerosis Risk in Communities (ARIC) Surveillance Study
Background: Trends for acute decompensated heart failure (ADHF) hospitalizations based on the primary discharge ICD codes have declined in the U.S. However, HF ICD codes are increasingly found in non-primary positions. Validation data are needed to estimate the frequency of ADHF hospitalizations.
Methods: The ARIC Study conducts surveillance for hospitalized ADHF in four U.S. communities for age ≥ 55 years since 2005. Hospital records are sampled, abstracted, and classified as ADHF or not by an expert physician panel. Analyses were stratified on code groups (a) 428.xx in primary-position, (b) 428.xx in non-primary position, and (c) other sampled HF ICD code (398, 402, 404, 415, 416, 425, 518, 786) in any position. We calculated ADHF probability in each group overall (positive predictive value, PPV), and by using regression models. We estimated the nationwide trends of ADHF hospitalizations from the National Inpatient Sample (NIS), a 20% probability sample of U.S. community hospitals, by applying the calibration factors derived in the ARIC study.
Results: In ARIC surveillance 42% of eligible hospitalizations (n=12,450 charts) validated as ADHF. NIS data included 9 million eligible hospitalizations during 1999-2010. The estimated numbers of US ADHF hospitalization in 2010 among Americans ≥ 55 years old was 1.8 (SE 0.02) million as compared to 0.8 (SE 0.002) million with 428.xx in the primary position (Figure).
The estimated ADHF hospitalizations in the U.S. increased from 1.6 million in 1999 to 1.9 million in 2006, and then decreased to 1.8 million in 2010 (average annual increase of 1%, p-trend <0.01). Estimated ADHF based on regression models for each of the three code groups gave similar results. The temporal increase was steeper among men and in age category 55-64 years than older ages.
Conclusions: Estimated frequency of ADHF hospitalizations by ARIC validation criteria is about two times higher than ICD 428 in primary position; with an overall increasing vs. declining trend over the last decade.
Author Disclosures: S.K. Agarwal: None. L. Wruck: None. M. Quibrera: None. K. Matsushita: None. L.R. Loehr: None. P.P. Chang: None. L.E. Chambless: None. W.R. Rosamond: None. J. Wright: None. G. Heiss: None. J. Coresh: None.
- © 2014 by American Heart Association, Inc.