Acute heart failure hospitalisations and outpatient post-discharge care: a German claims data study

Introduction Acute heart failure (AHF) is a leading cause of hospitalisations, with high rehospitalisation and mortality rates. The 2023 ESC guidelines recommend follow-up visits within six weeks after an AHF hospitalisation, but adherence in routine care remains unclear. Closing this gap is crucial for improving patient outcomes. Purpose To characterise adults hospitalised for AHF and assess their outpatient follow-up after index hospitalisation using German claims data 2014-2021. Methods This retrospective RWE study analysed data from the German Analysis Database (DADB; 4,1M insured). It included adults hospitalised with AHF, identified via ICD-10-GM codes for heart failure (I50), hypertensive heart disease (I11.0, I13.0, I13.2), or cardiomyopathy (I42) as the primary diagnosis. Secondary AHF diagnoses were included if hospitalised in cardiology, internal medicine, or emergency care. Myocardial infarction (I21) patients were also classified as AHF if they received mechanical circulatory support. The index hospitalisation was the first inpatient AHF diagnosis, with a 365-day pre-observation period free of AHF hospitalisations. Comorbidities during this period were assessed. The primary endpoint was outpatient follow-up within 90 days post-discharge, assessed in patients surviving the subsequent calendar year. Follow-up was based on documented I50 diagnosis or, if unavailable, broader circulatory diagnoses (ICD Chapter IX). Follow-up specialties were categorised as cardiologist, general practitioner (GP), other specialist, unknown, or no follow-up, prioritised in this order. The first post-discharge visit was classified as early (≤7 days) or late (>7 days). Results were extrapolated to the German statutory health insurance (SHI) population. Results From 2014 to 2021, the annual number of SHI-extrapolated AHF inpatients increased from 935,937 to 960,313 (mean age in 2021: 77.6 years; 48.7% female). AHF was the principal diagnosis in 11% of cases, both principal and secondary in 19%, and exclusively secondary in 70%. Of principal AHF diagnoses, 92% were coded as I50; for secondary diagnoses, 70% were I50, and 20% I11.0. Among patients with an AHF index hospitalisation (SHI: 4,234,295), 92% had at least one comorbidity, most commonly essential hypertension (85%), lipoprotein metabolism disorders (49%), and type 2 diabetes (38%). Among surviving patients (SHI: 3,120,671), 78% had outpatient follow-up with a GP, 15% with a cardiologist, and 2% had no follow-up. Of follow-up visits, 73% were early, while 27% were late. Conclusion The rising burden of AHF hospitalisations and high comorbidity prevalence emphasise the need for improved management strategies. While most patients received follow-up, care was mainly provided by GPs rather than cardiologists, with 1/4 experiencing late follow-up. Further studies should examine the burden on the healthcare system to assess early vs. late follow-up and improve post-discharge management.