Prevalence and incidence of heart failure hospitalizations from 2005 to 2023 and determinants of optimal treatment implementation in clinical practice: A population-based study in Northern Italy.

Background: We evaluated trends in prevalence and incidence of heart failure (HF) hospitalizations in Lombardy, and the characteristics of patients starting optimal medical treatment (O-HF-T: almost three among: diuretics, mineralocorticoid receptor antagonist, beta-blockers, ACE-inhibitors, Angiotensin Receptor Blockers). Methods: We analysed hospital discharge data with HF-related ICD9-CM recorded in the regional healthcare service from 2000 to 2023. Age-gender standardized HF prevalence and incidence rates were calculated from 2005 to 2023. Determinants of starting O-HF-T, in the three months after discharge, were investigated by Log-Binomial model. Results: HF incidence rates decreased from 790 per 100,000 years-person in 2005 to 564 per 100,000 in 2023; males had higher rates. Standardized prevalence rate increased until 2010, followed by a decrement peaking in the SARS-CoV2 pandemic year 2020. We investigated starting of O-HF-T, and its determinants, in a cohort of incident HF hospitalized patients from January 2010 to September 2019 to avoid the pandemic period (54022 patients, mean age 70 years, 60% males; 55% started O-HF-T within 90-days after discharge. The likelihood of starting O-HF-T was higher in younger males and in patients already treated with lipid-lowering, antidiabetic and antihypertensive drugs before the HF hospitalization. The likelihood of receiving O-HF-T decreased with age, in patients treated with antidepressants and in those with previous CV hospitalizations. Conclusions: The reduction of hospitalisations after 2010 can be explained by a combination of improved disease prevention and better care. Optimal medical treatment was achieved in about half of patients, mainly in younger males.