Hospitalization for Acute Heart Failure and In-Hospital Mortality Before, During, and After the COVID-19 Pandemic Period in France: A Nationwide Open Cohort Study from 2013 to 2023
Author(s)
Moulaire P1, Delory T2, Oghina S3, Espagnacq M4, Khlat M5, Le Coeur S5, Hejblum G1, Lapidus N6
1Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris, France, 2Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Centre Hospitalier Annecy-Genevois, French Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Epagny Metz-Tessy, France, 3AP-HP, Hôpitaux universitaires Henri-Mondor, Service de Cardiologie, Créteil, France, Créteil, France, 4Institute for Research and Information in Health Economics (IRDES), Paris, France, Paris, France, 5French Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, France, Aubervilliers, France, 6Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
Presentation Documents
OBJECTIVES: Numbers of hospital admissions for acute heart failure (AHF) have been reported to decrease in Europe by 9% to 66%, with corresponding in-hospital mortality estimates substantially variable. In the present study, the evolving patterns of AHF-related hospitalizations and in-hospital deaths in France during and after the COVID-19 pandemic were investigated.
METHODS: Analyses were based on the 2.8 million AHF hospitalizations recorded in the French National Health Data System (SNDS) between 2013 and 2023. We developed a Poisson regression model in which pre-pandemic years 2013 to 2019 were considered as the reference period for predicting the expected numbers of hospitalizations and in-hospital deaths in years 2020 to 2023. The differences between expected and observed numbers were estimated.
RESULTS: There were 39,274 [95% CI: 38,838; 39,685], 31,042 [30,630; 31,482], 46,624 [46,193; 47,087], and 57,816 [57,321; 58,261] fewer AHF-related hospitalizations than expected in years 2020, 2021, 2022, and 2023, respectively. The corresponding decreases ranged from 11.3% to 20.6%, and concerned more women (54%) than men. Simultaneously, 827 [724; 931], 1,625 [1,513; 1,730], 2,426 [2,316; 2,531], and 1,548 [1,447; 1,657] in-hospital deaths in excess were estimated for years 2020, 2021, 2022, and 2023, respectively. The corresponding increases ranged from 4.4% to 13.2%, and concerned more women (59%) than men.
CONCLUSIONS: During and after the pandemic years, the number of AHF-related hospital admissions was much lower than expected, while corresponding in-hospital deaths were simultaneously increased. These patterns were more marked in women. Deaths before hospitalization and more severe conditions upon hospital arrival during the pandemic may have contributed to the study findings. However, the dynamics of the pandemic per-se cannot explain why the disruptions were sustained over time and balanced towards women. The study results suggest the need for future research into structural changes in the French healthcare system.
Conference/Value in Health Info
Value in Health, Volume 27, Issue 12, S2 (December 2024)
Code
RWD29
Topic
Epidemiology & Public Health, Methodological & Statistical Research, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems, Public Health
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Infectious Disease (non-vaccine)