Evolving Burden and Outcomes of Chronic Left Ventricular Heart Failure: A German Nationwide Inpatient Analysis (2014–2022)

Background: Chronic left ventricular heart failure (CLHF) continues to pose a substantial healthcare burden, marked by high rates of hospitalization, complications, and mortality. This study analyses trends in in-hospital outcomes, comorbidities, and complications associated with CLHF in Germany over a nine-year period (2014–2022).

Methods: Nationwide inpatient data from the Federal Statistical Office of Germany (DESTATIS) were analyzed, covering 2,616,462 hospitalizations with a primary diagnosis of CLHF (ICD-10-GM I50.11–I50.14). Time trends were assessed for demographic variables, NYHA stage distribution, comorbidities, complications, in-hospital mortality, hospitalization duration, and healthcare costs.

Results: Between 2014 and 2019, CLHF-related hospitalizations increased by 8.3%, followed by a decline in 2020 and a partial rebound in subsequent years (Fig. 1A). The proportion of patients in NYHA IV decreased from 54.1% in 2014 to 50.4% in 2022 (p<0.0001). Comorbidities such as atrial fibrillation and chronic kidney disease increased, while diabetes and obesity declined. Rates of acute complications, including cardiogenic shock and acute kidney injury, rose significantly (both p<0.0001; Fig. 1C), paralleled by increased use of mechanical circulatory support devices. In-hospital mortality declined from 2014 to 2019 (8.0% to 7.6%) but peaked at 8.8% in 2022 (p<0.0001; Fig. 1B). Healthcare costs increased pre-pandemic, then dropped sharply in 2020 before recovering partially (Fig. 1D).

Conclusions: Our findings focus on the evolving complexity in CLHF management, influenced by an ageing population, rising comorbidities, and the disruptive impact of the COVID-19 pandemic. While therapeutic advances may have improved survival, increasing complications and persistent high mortality stress the ongoing challenges in inpatient care.