Trends in Heart Failure Hospitalizations in the Abruzzo Region, Italy, 2018-2023: Implications for Preventive Care and Integrated Primary Care Pathways.

Background: Hospitalizations for heart failure are commonly considered an indirect indicator of outpatient care effectiveness and continuity between hospital and community services. In 2021, the Abruzzo Region introduced a Diagnostic-Therapeutic Care Pathway (PDTA) for chronic heart failure, aimed at improving integrated management and reducing avoidable exacerbations. This study analysed trends in heart failure hospitalizations among residents of the Abruzzo Region from 2018 to 2023. Methods: We conducted a retrospective population-based study using regional hospital discharge records. Hospitalizations were identified according to the ICD-9-CM codes. Only admissions among adults with heart failure recorded as the principal diagnosis were included. Annual crude and age- and sex-standardized hospitalization rates were calculated using the 2018 Abruzzo resident population as the standard population. Temporal trends were assessed using Joinpoint regression. Results: Overall, 27,247 hospitalizations for heart failure were included. Annual admissions decreased from 5654 in 2018 to 3791 in 2023, corresponding to an approximate 33% reduction. Standardized hospitalization rates declined from 4.38 per 1000 inhabitants in 2018 to 2.85 per 1000 in 2023. Joinpoint analysis showed a significant decreasing trend, with an average annual percentage change of -9.1% (95% CI: -15.3 to -2.5). Conclusions: Heart failure hospitalizations significantly decreased in Abruzzo between 2018 and 2023. These findings may reflect changes in hospital use, pandemic-related effects, and progressive improvements in territorial chronic care management.