Coded socioeconomic and psychosocial factors in heart failure hospitalizations: associations with hospital stay, treatment use, and recorded diagnoses in Germany (2005–2022)

Socioeconomic and psychosocial factors (SPFs) are increasingly recognized as relevant to cardiovascular health. Their associations with length of stay, treatment use, and other diagnoses/outcomes in heart failure (HF) hospitalizations remain insufficiently studied.

We analysed nationwide mandatory Diagnosis Related Groups (DRG) data from 6 601 082 HF hospitalizations of patients who were discharged alive in Germany 2005–2022. Hospitalizations were stratified according to coded SPFs and compared regarding clinical characteristics, length of stay, treatment use, and diagnoses recorded during hospitalization. The primary outcome was prolonged hospital stay (>10 days), and treatment use and diagnoses recorded during hospitalization were additional outcomes.

Of 6 601 082 HF hospitalizations, 49 565 (0.8%) had at least one coded SPF. These hospitalizations involved older patients, a higher proportion of women, and a greater comorbidity burden. In the fully adjusted model, coded SPFs were associated with prolonged hospital stay (>10 days; OR 1.59, 95% CI 1.56–1.62; P < .001), deep venous thrombosis and/or thrombophlebitis (OR 1.39, 95% CI 1.28–1.52; P < .001), pulmonary embolism (OR 1.18, 95% CI 1.02–1.37; P = .026), and stroke (OR 1.35, 95% CI 1.19–1.53; P < .001). No associations were observed for myocardial infarction (OR 1.05, 95% CI 0.99–1.12; P = .138) or pneumonia (OR 1.03, 95% CI 1.00–1.06; P = .084). Coded SPFs were also associated with lower odds of PCI use (OR 0.85, 95% CI 0.80–0.90; P < .001) and LVAD implantation (OR 0.23, 95% CI 0.11–0.49; P < .001).

Among HF hospitalizations ending in live discharge, coded SPFs were associated with longer stays, lower use of selected therapies, and higher odds of selected diagnoses recorded during hospitalization. SPFs were markedly underrepresented in the German nationwide inpatient data.