Temporal Trends in Incidence and Prevalence of Heart Failure Hospitalization Among Medicare Beneficiaries

The burden of heart failure (HF) is projected to substantially increase, but contemporary national data on HF incidence and prevalence remain limited.

Medicare fee-for-service beneficiaries hospitalized with HF were analyzed from 2014 to 2021. Incident HF was defined as the first hospitalization after a 2-year lookback period without prior HF admissions. Prevalent HF was defined as at least 1 HF admission per patient per year. Annual incidence and prevalence rates per 1000 beneficiaries were calculated and analyzed using linear regression for 2014-2019 trends, with pandemic-era rates (2020/2021) compared with 2019 using Z-tests. We identified 2,634,645 incident HF hospitalizations (mean age 78.7 years, 51.8% female). Patient comorbidities evolved significantly, characterized by declining ischemic disease and rising obesity, diabetes, hypertension, and atrial fibrillation. HF prevalence increased from 14.23 to 15.88 per 1000 beneficiaries between 2014 and 2019 (P = .002), whereas the incidence increased from 10.68 to 11.67 per 1000 (P = .006). These patterns were disrupted during the COVID-19 pandemic, with prevalence decreasing to 13.19 per 1000 in 2020 and partially rebounding to 13.99 per 1000 in 2021; incidence similarly decreased to 9.51 per 1000 in 2020, partially rebounding to 10.56 per 1000 in 2021. Consistent disparities persisted across all study years, with the highest HF incidence and prevalence among males, older adults, and Black beneficiaries.

HF incidence and prevalence increased from 2014 to 2019, reversing previously declining trends. Persistent racial disparities remained evident throughout the study period. The COVID-19 pandemic was associated with changes in incidence and prevalence of HF, including diagnosis disruptions, that persisted through 2021.