Trends in Heart Failure Hospitalizations in the Abruzzo Region, Italy, 2018–2023: Implications for Preventive Care and Integrated Primary Care Pathways

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure (n=27247). Intervention: Time period (2018-2023) vs. 2018 baseline. Primary outcome: Standardized hospitalization rates for heart failure (per 1000 inhabitants) (AAPC -9.1%, 95% CI -15.3 to -2.5).

P Scampoli; Giuseppe Di Martino; F Meo; Pamela Di Giovanni; Francesco Cipollone; Donatella Taddeo; Edoardo Trebbi; Ferdinando Romano; Tommaso Staniscia

doi:10.3390/healthcare14162567

August 17, 2026HealthcareOpen Access

Trends in Heart Failure Hospitalizations in the Abruzzo Region, Italy, 2018–2023: Implications for Preventive Care and Integrated Primary Care Pathways

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Key result

Standardized heart failure hospitalizations fall ~35% between 2018 and 2023 in real-world cohort.

AAPC -9.1%
95% CI -15.3 to -2.5
n=27,247

Figures

Why the study?

Following the 2021 introduction of a Diagnostic-Therapeutic Care Pathway to improve integrated management, trends in heart failure hospitalizations in the Abruzzo Region were evaluated.

Key Points

To evaluate temporal trends in adult heart failure hospitalizations from 2018 to 2023 following regional health system reorganization and the introduction of an integrated chronic care pathway.
Conducted a retrospective population-based study of regional hospital discharge records identifying 27,247 admissions with heart failure as the principal diagnosis after excluding surgical and cardiac procedures.
Calculated annual crude and age- and sex-standardized hospitalization rates using the 2018 resident population as the standard population.
Evaluated temporal trends overall and across four Local Health Authorities using Joinpoint regression analysis.
Annual heart failure admissions decreased from 5654 (3.46% of total admissions) in 2018 to 3791 (2.27%) in 2023, representing an overall reduction of approximately 33%.
Age- and sex-standardized hospitalization rates fell from 4.38 per 1000 inhabitants in 2018 to 2.85 per 1000 in 2023, showing a significant average annual percentage change of −9.1% (95% CI: −15.3 to −2.5).
In-hospital mortality among heart failure admissions declined from 8.88% in 2018 to 7.57% in 2023 (p = 0.024, 95% CI: 0.19–2.43), driven largely by a 38.68% admission decrease among patients older than 74 years.

Study Design

Type

Observational (n=27,247)

Structured PICO

P

Population

27,247 hospital admissions for heart failure among adults in the Abruzzo Region of Italy, analyzed retrospectively between 2018 and 2023 to assess temporal trends.

O

Outcome

Annual crude and age- and sex-standardized hospitalization rates for heart failurehard clinical

Main Result

Effect estimate: AAPC -9.1% (95% CI -15.3 to -2.5)

Absolute Event Rate: 2.85% vs 4.38%

Heart failure hospitalizations in the Abruzzo Region of Italy significantly decreased by approximately 33% between 2018 and 2023, potentially reflecting changes in hospital use, pandemic effects, and progressive improvements in territorial chronic care management.

Limitations

Based on administrative hospital discharge records, which may be affected by coding variability and changes in admission practices
Heart failure identified only when recorded as the principal diagnosis, potentially underestimating the broader burden
Lack of clinical information such as ejection fraction, NYHA class, severity of disease, comorbidities, pharmacological treatment, or frailty
No information on outpatient follow-up, adherence to therapy, primary care management, use of telemedicine, home care, or rehabilitation
Absence of a control group, comparator region, or comparator condition
Inability to evaluate implementation fidelity of the PDTA or establish a causal relationship
Cannot demonstrate a causal effect of the PDTA
Available data did not allow measuring whether individual patients were actually managed according to the pathway
In-hospital mortality does not capture deaths occurring after discharge, 30-day mortality, long-term survival, readmissions or functional outcomes

Implication

HF hospitalization rates fell markedly in Abruzzo; supports evaluation of integrated pathways but should not yet alter practice or infer causality.

Abstract

Background: Hospitalizations for heart failure are commonly considered an indirect indicator of outpatient care effectiveness and continuity between hospital and community services. In 2021, the Abruzzo Region introduced a Diagnostic-Therapeutic Care Pathway (PDTA) for chronic heart failure, aimed at improving integrated management and reducing avoidable exacerbations. This study analysed trends in heart failure hospitalizations among residents of the Abruzzo Region from 2018 to 2023. Methods: We conducted a retrospective population-based study using regional hospital discharge records. Hospitalizations were identified according to the ICD-9-CM codes. Only admissions among adults with heart failure recorded as the principal diagnosis were included. Annual crude and age- and sex-standardized hospitalization rates were calculated using the 2018 Abruzzo resident population as the standard population. Temporal trends were assessed using Joinpoint regression. Results: Overall, 27,247 hospitalizations for heart failure were included. Annual admissions decreased from 5654 in 2018 to 3791 in 2023, corresponding to an approximate 33% reduction. Standardized hospitalization rates declined from 4.38 per 1000 inhabitants in 2018 to 2.85 per 1000 in 2023. Joinpoint analysis showed a significant decreasing trend, with an average annual percentage change of −9.1% (95% CI: −15.3 to −2.5). Conclusions: Heart failure hospitalizations significantly decreased in Abruzzo between 2018 and 2023. These findings may reflect changes in hospital use, pandemic-related effects, and progressive improvements in territorial chronic care management.

Discussion

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Cite This Study

Scampoli et al. (2026) conducted an observational in Heart failure (n=27,247). Time period (2018-2023) vs. 2018 baseline was evaluated on Standardized hospitalization rates for heart failure (per 1000 inhabitants) (AAPC -9.1%, 95% CI -15.3 to -2.5). Standardized heart failure hospitalization rates in the Abruzzo Region significantly decreased from 4.38 per 1000 inhabitants in 2018 to 2.85 per 1000 in 2023, with an average annual percentage change of -9.1%.

synapsesocial.com/papers/6a85643903308d306e2d7cc6 https://doi.org/10.3390/healthcare14162567

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Trends in Heart Failure Hospitalizations in the Abruzzo Region, Italy, 2018–2023: Implications for Preventive Care and Integrated Primary Care Pathways

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Trends in Heart Failure Hospitalizations in the Abruzzo Region, Italy, 2018–2023: Implications for Preventive Care and Integrated Primary Care Pathways

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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