Evolving trends and persistent challenges in chronic left ventricular heart failure management: insights from a 9-year analysis of in-hospital outcomes in Germany

Aims Chronic left ventricular heart failure (CLHF) represents a significant public health challenge globally, marked by high morbidity and mortality. CLHF is a leading cause of hospitalization, placing considerable strain on healthcare systems. This study aims to analyze in-hospital outcomes for CLHF patients in Germany over nine years (2014–2022), examining trends in morbidity, mortality, healthcare costs, and complications. Methods and results Data were sourced from the Federal Statistical Office (DESTATIS), covering 2,616,462 inpatient CLHF cases (ICD-10-GM I50.11-I50.14) in Germany from 2014 to 2022. CLHF hospitalizations increased from 288,019 in 2014 to 311,782 in 2019, then declined in 2020 but started again to rise from 2021 to 2022. The proportion of patients with advanced CLHF (NYHA stage IV) decreased slightly from 54.09% in 2014 to 50.36% in 2020 ( p < 0.0001). Notable comorbidity trends included rising rates of atrial fibrillation and chronic kidney disease. Complications such as cardiogenic shock and acute kidney injury increased over time (both p < 0.0001). Despite a decrease in mortality rates from 2014 to 2019 ( p < 0.0001), in-hospital mortality rose to 8.84% in 2022 ( p < 0.0001). Median revenue volume and hospitalization duration showed a pre-pandemic increase but declined in 2020. Conclusion The study highlights a complex interplay of factors affecting CLHF management in Germany, as a representative example for a high-income country. While advancements in treatment have improved some outcomes, the COVID-19 pandemic significantly impacted hospitalization trends and in-hospital mortality. The findings underscore the need for ongoing improvements in CLHF management and resilient healthcare strategies to address future challenges. Graphical abstract Overview of CLHF hospitalizations in Germany (2014–2022). Key findings include an 8.3% increase in hospitalizations from 2014 to 2019, followed by a temporary drop during the COVID-19 pandemic. Despite this, CLHF-related mortality peaked in 2022, highlighting the ongoing burden of severe cases. Rising costs and complications, alongside increasing comorbidities, emphasize the need for strengthened CLHF management and a resilient healthcare system. AF: atrial fibrillation, CLHF: Chronic left ventricular heart failure; CKD: chronic kidney disease, NYHA: New York Heart Association, Tsd: thousands.