Trends and Characterization of Hospitalizations with Heart Failure in Italy Before and During the COVID-19 Pandemic

Background/Objectives: Heart failure (HF) imposes a significant healthcare burden in aging populations. The COVID-19 pandemic disrupted care, raising concerns about chronic disease management. We analyzed temporal trends in HF hospitalizations in Italy (2008–2022), assessing the influence of demographics, clinical complexity, seasonality, and the pandemic. Methods: Using national discharge records, we strictly identified hospitalizations with a primary HF diagnosis via ICD-9-CM codes. Admissions were stratified by age, sex, season, and clinical severity according to the Elixhauser Comorbidity Index. Temporal trends were analyzed using a Negative Binomial Generalized Linear Mixed Model with the time component modeled through a segmented regression to account for pre-pandemic, pandemic (2020), and late-pandemic dynamics. Results: We identified 3,162,075 primary HF admissions, yielding a crude hospitalization rate of 35.11 per 10,000 person-years. Patients with an intermediate comorbidity burden (Elixhauser 13–20) accounted for 59.3% of the total volume. Multivariable analysis identified male sex (RR = 2.24, p < 0.001 ***), age ≥ 75 years (RR = 95.04 vs. 25–44, p < 0.001 ***), and winter seasonality as strong independent predictors. Trend analysis revealed a structural long-term decline across all severity tiers, driven by a sharp drop in 2020 (RR = 0.80, p < 0.001 ***) coincident with a spike in in-hospital mortality. While patients with low-to-intermediate comorbidity exhibited a partial rebound in 2021–2022 (overall RR = 1.06, p < 0.001 ***), admissions for highly complex patients (score > 20) showed an accelerated late-pandemic decline. Conclusions: HF hospitalizations in Italy remain a substantial burden driven by advanced age and clinical comorbidity. Our 15-year population-level data indicate no sustained, structural late-pandemic surge in HF admissions. The observed fluctuations were likely driven by severe healthcare disruptions and patient care avoidance rather than a true epidemiological shift, highlighting the urgent need for resilient chronic care systems during emergencies.