Long-lasting impact of the COVID-19 pandemic on incidence and mortality of patients hospitalized for acute heart failure: a nationwide cohort study of the entire French population from 2013 to 2023
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Background and aims
Healthcare pathways were reorganized in 2020 to manage the COVID-19 pandemic. Despite their urgent status, hospital admissions for acute heart failure (AHF) were reported to decline from 9% to 66% worldwide between 2020 and 2021, with divergent findings on in-hospital mortality. This study aims to describe and interpret the evolution of AHF hospitalizations and in-hospital mortality in France from 2020 to 2023.
Methods
Based on the 2.7 million AHF hospitalizations recorded in France (2013–2023), yearly numbers of hospitalizations and deaths expected between 2020 and 2023 were estimated using a Poisson regression model, with 2013–2019 as the reference period. The differences between observed and expected numbers of events were used to quantify the disruptions.
Results
A drop in AHF hospitalizations was estimated, starting at 39,271 [38,858; 39,688] (median [interquartile range]) in 2020 and peaking at 51,573 [51,113; 52,030] in 2023, for a total deficit of 168,518 [167,639; 169,408], representing a 15.3% decrease compared to the pre-pandemic trends. An excess in in-hospital mortality was estimated, rising from 827 [726; 928] excess deaths in 2020 to 2,426 [2,324; 2,530] in 2022, before declining to 1,731 [1,624; 1,838] in 2023 representing an increase from 8% to 12% compared to expected values. Both disruptions concerned more females than males. Multifactorial causes contribute to this increasing burden.
Conclusions
The apparent long-lasting impact of the COVID-19 pandemic on the management of AHF patients in France, particularly among females, suggests improving the preparedness for future crises, and requires addressing the current sustained disruptions.
