Heart failure hospitalization in Romania – A national multiannual study based on administrative dataset collection

Background Heart failure (HF) is a leading cause of hospitalization and mortality worldwide, with a substantial burden in Central and Eastern Europe. Romania lacks long-term national HF registries, making real-world administrative data an important source of epidemiological evidence. Methods We conducted a retrospective national study, using aggregated DRG reimbursement data reported by all public and private hospitals in Romania, between 2017 and 2022. HF hospitalizations were identified using ICD-10 codes (I50.x, I11.0). Key indicators included annual “HF hospital cases” and “HF patients”. Age distribution, length of stay, in-hospital mortality, and readmission frequency were collected for annual HF cohorts, with comparisons between pre-pandemic and COVID-19 pandemic periods. Results HF accounted for up to 14% of all “hospital cases”, with 550,000–590,000 annual HF episodes before the pandemic, declining by ~45% during COVID-19 pandemic. Approximately 1.4 hospitalization episodes per heart failure patient were recorded annually. Mean age was 70.1 (+/- 10) years and most hospitalized patients were ≥65 years old, although nearly 30% were <65 years. Mean length of stay was 6.7 days. In-hospital mortality for heart failure was consistently double that of all hospitalizations (4% vs. 2% pre-pandemic, increasing to 8-9% during the pandemic). One-year readmissions were very frequent, with >20% HF-related readmissions. Conclusions HF represents a major and persistent burden on the Romanian medical system, characterized by high mortality and readmission rates. These findings underscore the need for improved post-discharge management and national strategies to optimize HF care.