Trends and Characterization of Hospitalizations with Heart Failure in Italy Before and During the COVID-19 Pandemic.

Publication date: May 30, 2026

Background/Objectives: Heart failure (HF) imposes a significant healthcare burden in aging populations. The COVID-19 pandemic disrupted care, raising concerns about chronic disease management. We analyzed temporal trends in HF hospitalizations in Italy (2008-2022), assessing the influence of demographics, clinical complexity, seasonality, and the pandemic. Methods: Using national discharge records, we strictly identified hospitalizations with a primary HF diagnosis via ICD-9-CM codes. Admissions were stratified by age, sex, season, and clinical severity according to the Elixhauser Comorbidity Index. Temporal trends were analyzed using a Negative Binomial Generalized Linear Mixed Model with the time component modeled through a segmented regression to account for pre-pandemic, pandemic (2020), and late-pandemic dynamics. Results: We identified 3,162,075 primary HF admissions, yielding a crude hospitalization rate of 35. 11 per 10,000 person-years. Patients with an intermediate comorbidity burden (Elixhauser 13-20) accounted for 59. 3% of the total volume. Multivariable analysis identified male sex (RR = 2. 24, p 20) showed an accelerated late-pandemic decline. Conclusions: HF hospitalizations in Italy remain a substantial burden driven by advanced age and clinical comorbidity. Our 15-year population-level data indicate no sustained, structural late-pandemic surge in HF admissions. The observed fluctuations were likely driven by severe healthcare disruptions and patient care avoidance rather than a true epidemiological shift, highlighting the urgent need for resilient chronic care systems during emergencies.

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