Temporal shift in heart failure diagnoses among hospitalized patients within a large US integrated health system

Abstract Background Heart failure (HF) is a major cause of morbidity and mortality. Its rising prevalence and attributable cost have also made it a key focus in value-based care. Historically, most HF admissions among Medicare beneficiaries in the US have been disproportionately accounted for by a limited number of International Classification of Disease (ICD) diagnosis codes (I50.2, systolic heart failure; I50.3, diastolic heart failure; and I50.4, combined systolic and diastolic heart failure). In 2017, however, a significant shift in assigned codes was observed nationally, with hypertensive heart disease with heart failure (I11.0) and hypertensive heart disease with heart failure and chronic kidney disease (I13.0 and I13.2) accounting for a large majority of assigned ICD-10 codes (1). Purpose To better understand the pattern of assigned ICD-10 codes among patients hospitalized for HF since 2017. Methods We performed a retrospective cross-sectional analysis of patients admitted to a large integrated health system within the western US between 1/1/2018 and 10/1/2022 with a principal diagnosis of HF (defined by one of the above ICD-10 codes). More specifically, we sought to further understand the demographics, clinical characteristics, and treatment patterns of HF patients across all payers as part of a quality improvement initiative. Patient-level analyses were not performed; rather, all hospitalizations were considered independent events. Results Over the nearly 5-year period, 61,238 HF hospitalizations occurred, involving 43,234 patients, with 76% having more than 1 hospitalization. Hypertensive heart disease with HF and chronic kidney disease was the most common HF diagnosis, accounting for just over half of all admissions (Figure). Hypertensive heart disease with HF was the next most common HF diagnosis, accounting for just over one-third of admissions. Consistent with the previous observed shift in HF diagnoses among US Medicare beneficiaries in 2017, systolic HF, diastolic HF, and combined systolic and diastolic HF accounted for <10% of HF admissions in 2022. Conclusions Hypertensive heart disease with HF and chronic kidney disease and hypertensive heart disease with HF now constitute the predominant HF diagnoses for hospitalized patients across payers. This has important implications for quality improvement initiatives and health services research that utilize real-world data, as precise characterization of distinct phenotypes of HF may now be less reliant on coding than before.HF diagnoses (2018-2022)