Trends in hospitalization for heart failure in Scotland, 1990-1996 - An epidemic that has reached its peak?

Aims Studies in the 1980s and early 1990s showed striking increases in hosp italization rates for heart failure. This report describes contemporary tre nds in hospitalization for heart failure. Methods Scotland (population of 5.1 million) has a well described system fo r recording details of all hospitalizations. All hospital discharges (and d eaths) can be linked to each patient. We examined the period 1990-1996 (158 989 hospitalizations with a principal or secondary diagnosis of heart fail ure). Results Compared to 1990, the number of hospitalizations with a principal d iagnosis of heart failure increased in men (by 16%) and women (by 12%), alt hough the highest numbers were recorded in 1993 in women (21%) and in 1994 in men (24%). Similar trends were seen for the number of patients hospitali zed overall and those having a 'first ever' hospitalization. Hospitalizatio ns with a secondary diagnosis of heart failure increased much more striking ly (by 110% and 60% in men and women, respectively). Re-hospitalization bec ame more common, increasing by 53% and representing 23% of all hospitalizat ions in 1996. Median length of stay fell (from 9 to 8 days in men and 13 to 10 days in women with a principal diagnosis of heart failure), resulting i n 100 877 fewer inpatient days. Heart failure (principal diagnosis) still, however, accounted for 4.2% of all inpatient medicine/geriatric bed-days in 1996. Although inpatient case fatality fell slightly, the total number of deaths due to heart failure (principal diagnosis) increased slightly. Conclusions Heart failure continues to be a common cause of hospitalization . The previously reported 'epidemic' of increasing rates of hospitalization for heart failure in Scotland and elsewhere between 1980 and 1990, however , seems to have peaked (in about 1993/4). (C) 2001 The European Society of Cardiology.