Abstract: Background: Heart failure remains one of the leading causes of hospital admissions and mortality worldwide, with substantial regional disparities in clinical outcomes. These variations have been linked to differences in socioeconomic conditions, health determinants, and health-care system organisation. The aim of this study was to analyse regional differences in hospitalisation rates and in-hospital mortality for heart failure across Spain's autonomous communities, and to examine their associations with hospital characteristics and regional health determinants.
Methods: We conducted a nationwide, retrospective, population-based study using Spain's national hospital discharge database (Conjunto Mínimo Básico de Datos, CMBD) to identify adults (18 years) discharged from public general hospitals within the Spanish National Health System (SNS) with a primary diagnosis of heart failure from January 1, 2016, to December 31, 2022. Differences in hospitalisation rates and risk-standardised in-hospital mortality between autonomous communities were analysed, along with associations with hospital characteristics and regional health determinants.
Findings: A total of 764,083 hospitalisations for heart failure were analysed. The mean age of participants was 80.8 ± 10.6 years. The age- and sex-standardised hospitalisation rate was 255 per 100,000 inhabitants, with significant differences between autonomous communities. Crude in-hospital mortality rate was 11.3% (86,426 episodes), with substantial regional variation in risk-standardised mortality rate (ranged from 7.7% to 16.4%) No associations were found between hospital characteristics and risk-standardised mortality rate at the regional level. Regional health determinants were highly collinear; among all determinants assessed, per-capita gross domestic product was independently associated with lower risk-standardised mortality (betaGDPpc = -0.77; 95% CI: -1.04 to -0.49; p < 0.001; R2 = 0.77).
Interpretation: Significant regional differences in hospitalisation rates and risk-standardised mortality rates were observed among patients hospitalised for heart failure. Regional disparities in gross domestic product per capita may partly explain these differences. These results have clinical and policy implications, underscoring the need to consider socioeconomic determinants when analysing health outcomes and designing public policies aimed at reducing health inequalities. Our findings might be relevant to other European countries with similar public health systems.
Funding: This work was supported by the Spanish Society of Cardiology (Sociedad Española de Cardiología, SEC).
