Age-adjusted mortality from systolic heart failure (HFrEF) is almost double that of diastolic heart failure (HFpEF) over recent years, with significant racial disparity.

BackgroundHeart failure remains a leading cause of morbidity and mortality in the United States. Systolic heart failure (SHF; HFrEF) used to be considered as more lethal than diastolic heart failure (DHF; HFpEF). This study evaluates national age-adjusted mortality trends for SHF and DHF from 2016 to 2020, with particular attention to sex- and race-based differences. MethodsWe performed a retrospective analysis of adults [≥]20 years hospitalized with SHF or DHF in the Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2020. Age-adjusted mortality rates per 100,000 population were calculated using direct standardization to the 2000 U.S. standard population. Trends were stratified by sex and race to identify demographic disparities. ResultsWe identified 7.36 million SHF and 10.06 million DHF hospitalizations between 2016 and 2020. SHF maintained higher absolute mortality throughout the study, almost double that of diastolic heart failure (250.4 to 328.6 per 100,000; +31.2%), but DHF mortality rose more sharply in relative terms (164.1 to 225.8 per 100,000; +37.6%). From 2016-2019, mortality rates were relatively stable, but between 2019 and 2020, SHF mortality increased by 27.8% and DHF mortality by 33.5%. Minority populations experienced the steepest mortality surges, particularly Native American, Hispanic, and Black patients, narrowing their historical mortality gaps between SHF and DHF. Similarly, male DHF mortality increased disproportionately in 2020 (47.7% rise vs. 22.2% for females). ConclusionsDHF does represent the predominant heart failure phenotype in the United States in terms of hospitalization occurrences, and shows a faster growth trajectory in mortality relative to SHF. Importantly, however, SHF remains more lethal in absolute terms and has not come close to being surpassed by DHF despite a sharp rise in DHF mortality during 2020.