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.

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.