Hospitalisation for acute heart failure and in-hospital mortality before, during, and after the COVID-19 pandemic in France: A Nationwide cohort study from 2013 to 2024

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Abstract Introduction Healthcare systems were reorganised 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 regarding in-hospital mortality. This study aimed to investigate in detail the evolution of AHF hospitalisations and in-hospital mortality in France from 2013 to 2024. Methods Based on the 2.9 million AHF hospitalisations recorded in France from 2013 to 2024, yearly numbers of hospitalisations and deaths expected in years 2020 to 2024 were estimated using a Poisson regression model, with 2013–2019 as the reference period. The differences between observed and expected event counts in the years 2020 to 2024 were used to quantify the disruptions that occurred since the emergence of the pandemic. Results A total deficit of −222,913 [−223,908; −221,926] (mean [95% CI]) AHF hospitalisations was estimated for the 2020-2024 years, corresponding to a 16.1% decrease compared to pre-pandemic trends. The yearly reduction in AHF hospitalisations worsened over time, from −39,268 [−39,685; − 38,847] fewer cases in 2020 to −55,521 [−55,984; −55,051] in 2024. In parallel with the decline in AHF hospitalisations, estimated excess in-hospital deaths were 828 [729; 928], 1,625 [1,517; 1,731], 2,427 [2,323; 2,531], 1,739 [1,634; 1,844], and 1,175 [1,068; 1,281] for the years 2020 to 2024, respectively. These correspond to relative increases in in-hospital mortality ranging from 4.4% to 13.2% compared to expected values. The disruptions in both hospital admissions and in-hospital mortality affected more females than males. Conclusions The apparent long-lasting changes in the management of AHF patients in France observed since the COVID-19 pandemic emergence, particularly among females, suggest improving the preparedness for future crises and require addressing the current sustained disruptions. Key Messages What is already known on this topic In 2020 and 2021, hospitalisations for acute heart failure were reported to decline worldwide following the onset of the COVID-19 pandemic. However, findings on concomitant in-hospital mortality have remained unclear, and little is known about whether these disruptions persisted through 2022 to 2024. What this study adds Analyses of exhaustive French national data indicate that the decline in admissions observed in 2020 persisted and even worsened through 2024, with an overall decrease of 16.1%. In parallel, in-hospital mortality was estimated in each year from 2020 to 2024, and the resulting excess corresponded to a cumulative increase of 8.4%. Females were more impacted than males by both disruptions. How this study might affect research, practice or policy This study highlights critical warnings on ongoing disruptions affecting patients hospitalised for acute heart failure in France and identifies the subpopulations most impacted. These findings might contribute to guide targeted mitigation strategies and to enhance the preparedness of national health systems for future health crises.

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