INCREASE IN-HOSPITAL ADMISSION RATES FOR HEART-FAILURE IN THE NETHERLANDS, 1980-1993

Objective-To study the trend in hospital admission rates for heart fai lure in the Netherlands from 1980 to 1993. Design-All hospital admissi ons in the Netherlands with a principal discharge diagnosis of heart f ailure were analysed. In addition, individual records of heart failure patients from a subset of 7 hospitals were analysed to estimate the f requency and timing of readmissions. Results-The total number of disch arges for men increased from 7377 in 1980 to 13 022 in 1993, and for w omen from 7064 to 12 944. From 1980 through 1993 age adjusted discharg e rates rose 48% for men and 40% for women. Age adjusted in-hospital m ortality for heart failure decreased from 19% in 1980 to 15% in 1993. For all age groups in-hospital mortality for men was higher than for w omen. The mean length of hospital admissions in 1993 was 14.0 days for men and 16.4 days for women. A review of individual patient records f rom a 6.3% sample of all hospital admissions in the Netherlands indica ted that within a 2 year period 18% of the heart failure patients were admitted more than once and 5% more than twice. Conclusions-For both men and women a pronounced increase in age adjusted discharge rates fo r heart failure was observed in the Netherlands from 1980 to 1993. Rea dmissions were a prominent feature among heart failure patients. Highe r survival rates after acute myocardial infarction and the longer surv ival of patients with heart disease, including heart failure may hare contributed to the observed increase. The importance of advances in di agnostic tools and of possible changes in admission policy remain unce rtain.