Contemporary trends in outcomes after heart failure hospitalization among medicare beneficiaries

Background Contemporary trends in outcomes after heart failure (HF) hospitalisation, particularly during and after the COVID-19 pandemic, are not well characterised. Purpose This study analysed temporal trends in outcomes after HF hospitalisation among Medicare beneficiaries from 2016 to 2022. Methods This retrospective cohort study used national Medicare data to analyse the first HF hospitalisation per beneficiary each year. Medicare is the United States' federal health insurance programme covering nearly all adults aged ≥65 years. Beneficiaries enroll in either traditional Fee-for-Service (FFS), a public payer model, or Medicare Advantage (MA), a private managed-care alternative. Trends in 30-day mortality, readmission, and home time (days alive and out of healthcare facilities) were examined across the pre-pandemic (2016–2019) and post-pandemic (2020–2022) periods, using generalised estimating equations stratified by sex, race/ethnicity, Medicare plan type, and HF subtype. Results The cohort included 4,957,047 HF hospitalisations (mean age 78 years; 52% female; 16% Black). Adjusted 30-day mortality declined pre-pandemic (9.01 to 8.38 per 1,000; aRR 2019 vs 2016 [95%CI]: 0.93[0.92–0.94]), increased in 2020 (9.13 per 1,000), and declined again to 8.49 per 1,000 by 2022 (aRR 2022 vs 2020: 0.93[0.92–0.94]), remaining slightly higher than 2019. Mortality was consistently higher in males and White beneficiaries, whereas Black beneficiaries exhibited the lowest mortality rates. Medicare FFS (vs MA) beneficiaries had higher mortality rates, and the gap widened over time. Readmission rates declined pre-pandemic (aRR 2019 vs 2016: 0.98[0.98–0.99]) and post-pandemic (aRR 2022 vs 2020: 0.96[0.95–0.97]). Mean home time increased pre-pandemic (25.77 to 25.97 days; aRR 2019 vs 2016: 1.008[1.007–1.009]), plateaued in 2020, then increased again in 2022 (aRR 2022 vs 2020: 1.003[1.002–1.003]). Conclusions HF outcomes improved in the pre-pandemic period, worsened in 2020, and partially recovered by 2022. Medicare FFS had worse 30-day outcomes vs MA, with the difference widening over time. The lower acute mortality observed among Black beneficiaries likely reflects the fact that Black patients have earlier HF onset, and the sickest patients from reaching Medicare age, resulting in a comparatively healthier population in the Medicare cohort.