Contemporary Trends in Outcomes After Heart Failure Hospitalization Among Medicare Beneficiaries.

BACKGROUND: Contemporary trends in outcomes after heart failure hospitalization (HFH), particularly during and after the COVID-19 pandemic, are not well characterized. OBJECTIVES: This study analyzed temporal trends in outcomes after HFH among Medicare beneficiaries from 2016 to 2022. METHODS: This retrospective cohort study used national Medicare data and included patients who were hospitalized with a principal discharge diagnosis of heart failure between January 2016 and December 2022. Trends in adjusted 30-day mortality, readmission, and home time (days alive and out of health care facilities) were examined across the prepandemic (2016-2019) and postpandemic (2020-2022) periods, using generalized estimating equations stratified by sex, race/ethnicity, Medicare plan type (fee-for-service [FFS] vs Medicare Advantage), and HF subtype. RESULTS: A total of 4,957,054 HFHs were identified (mean age: 78 years; 52% female; 16% Black). Adjusted 30-day mortality declined prepandemic (9.01 to 8.38 per 100; adjusted risk/rate ratio [aRR] 2019 vs 2016: 0.93 [95% CI: 0.92-0.94]), increased in 2020 (9.13 per 100), and declined again to 8.49 per 100 by 2022 (aRR 2022 vs 2020: 0.93 [95% CI: 0.92-0.94]), remaining slightly higher than 2019. Mortality was consistently higher in men (vs women) and White (vs Black) beneficiaries. Medicare FFS (vs Medicare Advantage) beneficiaries had higher mortality rates, and the gap widened over time. One-year mortality trends were similar to 30-day mortality trends. Readmission rates declined prepandemic (aRR 2019 vs 2016: 0.98 [95% CI: 0.98-0.99]), plateaued in 2020, and declined again postpandemic (aRR 2022 vs 2020: 0.96 [95% CI: 0.95-0.97]). Readmission rates were higher in men (vs women), Black (vs White), and FFS (vs Medicare Advantage) beneficiaries. CONCLUSIONS: Among Medicare beneficiaries hospitalized for HF, outcomes improved over time in the prepandemic period, worsened or plateaued during the pandemic, and then improved again in the postpandemic period. Black patients had lower 30-day mortality but higher readmission rates. FFS beneficiaries consistently had worse outcomes compared with Medicare Advantage beneficiaries.