Trends in acute decompensated heart failure admissions and healthcare costs in U.S. emergency departments

Authors

• Ronaldo Pichardo-Gonzalez, Department of Internal Medicine, The George Washington University Hospital, Washington, DC, USA.
• Katrina K. Le, Department of Emergency Medicine, The George Washington University Hospital, Washington, DC, USA.
• Quincy K. Tran, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Program In Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
• Anushka Deogaonkar, Department of Internal Medicine, The George Washington University Hospital, Washington, DC, USA.
• Jacob Offer, Department of Emergency Medicine, The George Washington University Hospital, Washington, DC, USA.
• Courtney Paul, Department of Internal Medicine, The George Washington University Hospital, Washington, DC, USA.
• Ali Pourmand, Department of Emergency Medicine, The George Washington University Hospital, Washington, DC, USA. Electronic address: [email protected].

Document Type

Journal Article

Publication Date

3-2-2026

Journal

The American journal of emergency medicine

Volume

104

DOI

10.1016/j.ajem.2026.02.040

Keywords

Admissions; Emergency departments; Healthcare; Heart failure; Non-compliance

Abstract

BACKGROUND: Acute decompensated heart failure (ADHF) is commonly managed in emergency departments (ED) and poses significant morbidity and mortality burden. This study quantifies trends in demographics and healthcare charges related to ADHF across EDs in the US. METHODS: A descriptive retrospective epidemiological analysis of nationally representative ED visit-level data was conducted using the Nationwide Emergency Department Sample (NEDS) database from 2016 to 2021. NEDS is a publicly available database maintained by the Healthcare Cost and Utilization Project (HCUPS). Adult patients with acute heart failure (HFrEF or HFpEF) were identified through ICD-10 codes. Survey-weighted estimates were used to generate national counts and characterize demographics, comorbidities, hospital characteristics, and disposition outcomes. Temporal trends in ED visits, admission rates, and healthcare charges were analyzed. RESULTS: A total of 10,041,919 ED encounters for ADHF were identified, with 43.6% female and a mean age of 69.8 years. Of these, 33.7% lived in low-income areas, and 83.6% were treated in metropolitan hospitals (primarily in the South, 40.8%). Most patients (82.8%) were admitted from the ED, with a low in-ED mortality rate of 0.1%. Of all patients, 5% were non-compliant with care. Trend analysis shows an increasing number of ADHF patients and rising non-compliance rates, with mean total hospital charges escalating from $71,578 in 2016 to $98,705 in 2021. CONCLUSION: This study underscores the substantial burden of ADHF on the healthcare system, with rising admissions and charges, contrasting with low in-ED mortality. Addressing these trends is essential to mitigate resource strain and enhance patient outcomes.

APA Citation

Pichardo-Gonzalez, Ronaldo; Le, Katrina K.; Tran, Quincy K.; Deogaonkar, Anushka; Offer, Jacob; Paul, Courtney; and Pourmand, Ali, "Trends in acute decompensated heart failure admissions and healthcare costs in U.S. emergency departments" (2026). GW Authored Works. Paper 8944.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8944

Department

School of Medicine and Health Sciences Resident Works