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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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 2020-2024 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 2020-2024 were used to quantify the disruptions that occurred since the emergence of the pandemic. Results: A total deficit of -222 913 (-223 908 to -221 926) (mean (95% CI)) AHF hospitalisations was estimated for the years 2020-2024, corresponding to a 16.1% decrease compared with pre-pandemic trends. The yearly reduction in AHF hospitalisations worsened over time, from -39 268 (-39 685 to -38 847) fewer cases in 2020 to -55 521 (-55 984 to -55 051) in 2024. Between 2020 and 2024, 7794 (7557 to 8028) excess in-hospital deaths were estimated, corresponding to an 8.4% excess compared with pre-pandemic trends. From 2021 to 2024, this excess ranged from 9.6% to 16% for females compared with 7.1% to 11.1% for males. Conclusions: The apparent long-lasting changes in the management of patients with AHF in France observed since the COVID-19 pandemic emergence, particularly among females, suggest further research for better understanding the sustained observed disruptions.

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