Heart failure hospitalizations among young adults are getting more common and more expensive
Hospitalizations for heart failure (HF) are on the rise among young adults, according to a new study published in JACC: Heart Failure.[1]
“HF hospitalizations, especially among young adults, constitute an important cause of loss of productive work years and health care resource utilization,” wrote Vardhmaan Jain, MD, a specialist with the department of medicine at Cleveland Clinic, and colleagues. “Yet the large majority of published data from routine U.S. clinical practice stem from middle-aged or older adults with HF, such as those with Medicare insurance.”
Jain et al. tracked data from the National Inpatient Sample, focusing on more than 767,000 HF hospitalizations among young adults from 2004 to 2018. All patients were between the ages of 18 and 45 years old, the mean patient age was 38 years old, 62.9% were men and 50.1% were black. Black men (30.4%) and black women (37.1%) were the two racial groups most likely to be hospitalized for HF over the course of the study period. Also, hospitalizations for HF were more common in the South (47.5%) than other parts of the United States.
HF hospitalizations among these younger patients actually decreased from 2004 (2.43 per 10,000 person-years) to 2012 (1.82). However, that number then increased from 2013 (1.83) to 2018 (2.51).
The study also revealed signs of multiple disparities in care.
“Among patients with HF, there is evidence of structural racism and care disparities in black patients; they are less likely to receive accessible ambulatory care that could decrease the need for hospitalization, be admitted under the care of a cardiologist, or be admitted to a cardiac unit,” the authors wrote. “We also found that the half of young adults who are hospitalized for HF belong to the most socially vulnerable section of the population and live in zip codes in the lowest quartile of income.”
In addition, researchers noted, heart failure continues to cost health systems — and patients — a considerable amount of money. Even when adjusting for inflation, the cost of HF hospitalizations has continued to rise over the years, increasing from $12,500 per hospitalization in 2014 to $16,700 in 2018.
“These trends are consistent with those seen in the overall HF population in the United States,” the authors wrote. “This likely underestimates the cost to society given the loss of workdays incurred by the economically productive demographic. Our data suggest that this increase in the cost of care could be explained in part by procedural utilization during the same time period, further heightened by the rise in discharges to long-term care facilities. Although policy measures such as the Affordable Care Act of 2010 have increased care utilization, especially among Medicaid beneficiaries, there remain care gaps that need to be filled to meet the health care needs of historically marginalized people who constitute a major proportion of HF admissions.”
The team also called for addition research involving physicians, policy makers, stakeholders and payers to examine “the rising burden of HF, with a focus on the economically productive young middle age demographic.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.