Hospitalizations for heart failure: still major differences between East and West Germany 30 years after reunification - Dorr, M.; Riemer, U.; Christ, M.; Bauersachs, J.; Bosch, R.; Laufs, U.; Neumann, A.; Scherer, M.; Stork, S.; Wachter, R. (ESC Heart Fail, 2021)
AIMS: Heart failure (HF) is the most common primary inpatient diagnosis in Germany. We examined temporal trends of HF hospitalization within Germany focusing on regional differences. METHODS AND RESULTS: We analysed aggregated data of more than 320 million hospitalizations in Germany from 2000 to 2017. Temporal trends of HF-related parameters were analysed, focusing on regional differences between the federal states. The absolute number of HF-related hospitalizations throughout Germany increased continuously and almost doubled (from 239 694 to 464 724 cases, +94%) with the relative increase being higher in East Germany compared with West Germany (119% vs. 88%). These regional differences persisted after age standardization with 609 and 490 cases per 100 000 population, respectively. The length of stay decreased continuously across Germany (from 14.3 to 10.2 days; -29%), while the total number of HF-related hospital days increased by 51% in East Germany and 35% in West Germany. In 2017, HF remained the leading cause of in-hospital death (8.9% of all cases), with a markedly higher rate in East vs. West Germany (65 vs. 43 deaths per 100 000 population). CONCLUSIONS: Heart failure remains the most common cause of hospitalization and in-hospital death throughout Germany. The increase in HF-related morbidity and mortality was much higher in East Germany compared with West Germany during the observation period. A more detailed understanding of these striking disparities 30 years after the German reunification requires further investigations. There is an urgent need for action with regard to stronger control of risk factors and improvement of both chronic HF management and healthcare structures.
Keywords: journalArticle; *Heart Failure/epidemiology; *Hospitalization; CVRx, MSD, Boehringer Ingelheim, AstraZeneca, Abiomed, Abbott, and Medtronic and; Daichii Sankyo, Boehringer Ingelheim, and Amgen. R.W. has been a consultant for; Epidemiology; Germany; Germany, West; Germany/epidemiology; Heart failure; Hospital Mortality; Hospitalization; Humans; In-hospital mortality; Ingelheim, Bristol Myers Squibb, CVRx, Daiichi, Johnson & Johnson, Medtronic,; M.S., A.N., and S.S. report no conflicts of interest. M.D. reports honoraria for; Medtronic and research support from BMS, Pfizer, Biotronik, and Abbott. U.L. has; Novartis, Pfizer, Sanofi, and Servier; Regional disparities; consulting from Novartis, BMS, Pfizer, Vifor, Bayer, Servier, Daichii Sankyo,; is an employee of Novartis Germany. J.B. reports honoraria for lectures and/or; lectures and/or consulting from Bayer, Daiichi Sankyo, Hexal, and Novartis. U.R.; lectures and/or consulting from Novartis, BMS, Pfizer, Bayer, Biotronik, and; or received speaker's bureau honoraria from Bayer, Berlin Chemie, Boehringer; received honoraria for lectures and/or consulting from Novartis, Bayer, Servier,; research support from Zoll, CVRx, Vifor, and Abiomed. R.B. reports honoraria for; to the research, authorship, and/or publication of this article: M.C., U.L.,