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  • Clinical Management and Economic Drivers of Heart Failure With Preserved or Mildly Reduced Ejection Fraction

A Systematic Literature Search and Narrative Synthesis of Economic Drivers in Hospitalizations for Heart Failure With Preserved or Mildly Reduced Ejection Fraction in the United States

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This supplement is supported by Bayer.

ABSTRACT

Background: Heart failure (HF) with mildly reduced ejection fraction (HFmrEF) or preserved EF (HFpEF) constitutes 74% of all HF cases in the US and is associated with significant clinical and economic burdens. Hospitalizations for HFmrEF/HFpEF are a leading contributor to the rising economic burden of HF. This literature review aims to identify key drivers of hospitalization costs for patients with HFmrEF/HFpEF in the US and to inform targeted interventions to reduce health care expenditures.

Methods: A comprehensive search of MEDLINE and Embase was conducted to identify observational studies published between January 2022 and May 2025 that reported on hospitalization-related costs for US adults with HFmrEF/HFpEF (defined as left ventricular ejection fraction ≥ 40%). Eligible studies were those reporting direct costs of hospitalization, readmission rates, time to readmission, length of stay, and number of hospitalizations per person. Data were synthesized narratively, and costs were adjusted to 2025 US$.

Results: Of 2624 records identified by the literature searches, 37 studies met inclusion criteria. Total annual costs for HFmrEF/HFpEF were $36,921 to $49,081 per person per year (PPPY), with inpatient hospitalizations accounting for nearly half ($18,844-$20,095 PPPY). Readmissions were a major cost driver, with median all-cause readmission costs ($21,371-$28,615) consistently higher than index admission costs ($13,763-$14,944). Approximately 20% of patients were readmitted within 30 days, with HF-specific readmissions accounting for one-third of 30-day readmissions. Comorbidities such as type 2 diabetes (T2D) and chronic kidney disease (CKD) significantly increased costs, with patients having multiple morbidities incurring nearly double the costs of individuals without comorbidities. Prolonged hospital stay was also linked to higher costs.

Conclusions: HFmrEF/HFpEF hospitalizations represent a significant economic burden that is driven by high inpatient costs, frequent readmissions, and coexisting conditions (eg, T2D, CKD). These findings highlight the need for improved adherence to guideline-directed medical therapy and better management of comorbidities. Policymakers and health care providers should prioritize strategies to reduce HF-related hospitalizations and readmissions to mitigate the growing economic impact of HF.

Am J Manag Care. 2026;32(suppl 6):S95-S111. https://doi.org/10.37765/ajmc.2026.89949

For author information and disclosures, see end of text.

Introduction

Heart failure (HF) is a highly prevalent and serious medical condition characterized by the heart’s inability to pump sufficient blood and oxygen to support other organs in the body. HF is associated with high mortality and morbidity, impacting a patient’s quality of life and imposing a substantial burden on the health care system.1-4 In 2024, approximately 6.7 million people in the United States were living with a diagnosis of HF; this figure is expected to rise to 8.7 million by 2030.2 About one-third of the adult population in the US is at risk for developing HF, with this risk heightened in individuals with obesity and hypertension.2 The incidence and prevalence of HF are disproportionately higher among Black individuals compared to those of other racial and ethnic groups.2 HF is most prevalent among adults older than 60 years.2

Additional trends in incidence and prevalence can be better understood by examining the specific subtypes of HF. Left ventricular ejection fraction (LVEF), a measurement that reflects the heart’s pumping efficiency, is used to categorize HF into 3 subtypes: HF with reduced ejection fraction (HFrEF), defined as an LVEF of 40% or less; HF with mildly reduced EF (HFmrEF), defined as an LVEF of 41% to 49%; and HF with preserved EF (HFpEF), which is defined as an LVEF of 50% or more.5 These subtypes are increasingly recognized as distinct clinical entities characterized by unique pathophysiological mechanisms and management challenges. HFmrEF and HFpEF together make up about 74% of all HF cases2 and account for approximately 500,000 hospitalizations per year in the US. Long-term cohort studies in individuals with no HF at baseline report incident rates of 0.7 to 29 per 1000 person-years for HFmrEF/HFpEF hospital admissions.6-12 Additionally, comorbidities such as diabetes, subclinical myocardial stress or injury, and smoking are associated with significantly higher risks of HFmrEF/HFpEF hospitalizations.10

Hospitalizations are the primary driver of health care costs in HF, accounting for most of the economic burden of the disease. Systematic review evidence indicated that hospitalization was a principal driver of HF costs. Estimated annual mean all-cause hospitalization costs (2019 US$) in people with HF were $26,998 per person per year (PPPY) (range, $12,959-$53,382; 3 studies), mean HF-specific hospitalization costs were $19,907 PPPY (range, $8972-$42,231; 6 studies), and mean total medical costs for any HF were $29,118 PPPY (range, $14,226-$45,784; 5 studies).13 Notwithstanding some heterogeneity in these cost estimates, hospitalization clearly accounts for a considerable proportion of costs associated with HF. Another systematic review reported mean costs per hospitalization episode for any HF ranging from $10,737 to $17,830 (4 studies); for the HFpEF and HFrEF subgroups, the estimated mean costs per hospitalization were $7860 to $10,551 and $11,600 to $17,779, respectively (2019 US$).14 These findings suggest that hospitalization costs for HFpEF may be slightly lower than those for HFrEF, yet the higher prevalence of HFpEF could lead to a substantial cumulative economic burden.

Additionally, the drivers of hospitalization costs may differ between HF subtypes.HFrEF hospitalizations are often associated with acute decompensation,15 but HFmrEF and HFpEF hospitalizations may be more likely to be driven by comorbidities such as diabetes, chronic kidney disease (CKD), and hypertension.2 These differences in clinical presentations may result in variations in resource use and cost composition across HF subtypes. Understanding these cost drivers is critical to identifying opportunities for cost reduction and improving care delivery.

While overall HF mortality, hospitalization, and readmission rates in the US increased between 2014 and 2024,2 the proportion of HF hospitalizations attributed to HFpEF has also increased.16-18 This trend has significant implications for the economic burden of HF, particularly given the limited guideline-recommended treatment options available for HFmrEF and HFpEF compared to HFrEF. Current US guidelines for HF management include a class 2a recommendation for use of SGLT2 inhibitors (SGLT2is) in HFpEF.5 This was supported by moderate strength of evidence from high-quality trials (eg, EMPEROR-Preserved [NCT03057951] and DELIVER [NCT03619213]) showing fewer HF-related hospitalizations among patients with HFmrEF and HFpEF given an SGLT2i.19,20 However, guideline recommendations for mineralocorticoid receptor antagonists (MRAs) remain weaker—they do not distinguish between steroidal and nonsteroidal MRAs (nsMRAs) despite emerging evidence suggesting that nsMRAs may be particularly effective in improving clinical outcomes for HFpEF patients, especially when they are used alongside SGLT2is.21-23 These gaps in guideline recommendations highlight the unmet need for more robust evidence and effective therapies tailored to HFmrEF and HFpEF.

The growing body of evidence about agents like SGLT2is and nsMRAs suggests promising opportunities to address these unmet needs. These therapies may reduce hospitalizations in HFmrEF and HFpEF populations and, by extension, reduce overall health care costs by improving patient outcomes and decreasing the frequency of costly hospital stays. As the evidence base for these therapies continues to expand, there is scope for guideline recommendations to evolve, which will provide greater certainty about the effects of these medications and provide stronger guidance for their use in HFmrEF and HFpEF. In the context of these promising developments, there is a lack of up-to-date synthesis of evidence on the specific factors driving hospitalization costs for HFmrEF and HFpEF.

In this literature review, hospitalization costs associated with HFmrEF and HFpEF were investigated systematically. A key focus was the understanding of factors that drive such costs. While HFrEF is a known and significant contributor to HF-related costs, HFmrEF and HFpEF represent distinct subtypes that account for a substantial proportion of HF cases and hospitalizations. By identifying potentially modifiable cost drivers specific to HFmrEF/HFpEF, this review is intended to inform strategies to reduce costs and support the development and implementation of interventions that improve outcomes and reduce the financial burden of managing HFmrEF and HFpEF.

Methods

This literature review was undertaken using methods adapted from best practice recommendations outlined in the Cochrane Handbook for Systematic Reviews of Interventions.24 We did not produce a full protocol for the review, but all eligibility criteria and search strategies were decided a priori. A comprehensive literature search was conducted using MEDLINE and Embase via Ovid to identify peer-reviewed, observational studies and investigate the main cost drivers of hospitalization for HFmrEF/HFpEF. Additionally, we examined the citation lists of relevant published systematic literature reviews (SLRs) to capture studies not identified in the bibliographic database search. Eligible studies were conducted in the US and published in English, and they reported predefined outcomes of interest. To capture the most up-to-date evidence generated since the approval of SGLT2i therapies to treat HF with LVEF exceeding 40%, the search was limited to studies published from January 1, 2022, to the date of the search (May 16, 2025). The search strategy was developed using controlled vocabulary terms (Medical Subject Headings in MEDLINE and Emtree terms in Embase) in combination with free text terms and a search filter for cost and health care resource use (HCRU) studies adapted from filters published by Canada’s Drug Agency and the Scottish Intercollegiate Guidelines Network.25,26 (The full search strategy is presented in Table S1.)

To be eligible, participants needed to be adults 18 years or older who were admitted to the hospital with HFmrEF, HFpEF, or HF with an LVEF of 40% or higher. Although the accepted definitions of HFmrEF and HFpEF are an LVEF of 41% to 49% and an LVEF of 50% or more, respectively,5 we did not exclude studies that used different thresholds for HFmrEF or HFpEF, and we did not exclude studies reporting data for HF with an LVEF of at least 40% but that did not use the terms HFmrEF or HFpEF. There were no restrictions on interventions or comparators. The outcomes of interest included direct costs and HCRU in individuals hospitalized for HFmrEF/HFpEF, stratified by first and subsequent admissions, and type of hospital (eg, academic, rural, or urban); HF readmissions and all-cause readmissions; duration between the diagnosis of HFmrEF/HFpEF and the first and subsequent hospitalizations; proportion of HF admissions, HF readmissions, and all-cause hospital admissions; readmission rates at 30, 60, and 90 days; and number of hospitalizations per patient. The full inclusion criteria are presented in Table 1.

Studies did not have to report direct costs to be included in the review; data reported for any of the stated outcomes were deemed sufficient for inclusion. Studies reporting charges rather than costs (ie, the amount billed by the hospital for the entire hospital stay rather than simply the cost of delivering services) were also included; charges do not directly reflect the actual costs of care, but they provide valuable insights into the financial burden of hospitalization. Additionally, all studies reporting outcomes of interest were included in the literature review, regardless of the primary study’s objective (ie, the included studies did not have to have the primary objective of investigating hospitalization costs). This approach was taken to produce the most comprehensive summary possible of the available body of evidence.

The literature was reviewed in 2 phases, with screening conducted by a single reviewer at the title/abstract review and the full-text review levels. All publications that met the inclusion criteria were included in the review. All data relevant to the prespecified outcomes were extracted from each study that met the inclusion criteria. All costs were inflated to 2025 US$ using the US Bureau of Labor Statistics Consumer Price Index Inflation Calculator tool (accessed July 2025 from https://www.bls.gov/data/inflation_calculator.htm). Data were summarized in tabulated form and synthesized narratively, with data presented separately for HFmrEF and HFpEF whenever data stratification and reporting in the included studies made this possible.

This study was not submitted for institutional review board approval, since it is based entirely on secondary, unidentifiable data and therefore is not required to comply with human subject protection and consent requirements.

Results

The bibliographic database searches identified 2624 unique records, of which 512 full-text articles were assessed for eligibility. Thirty-seven studies (39 publications) met the inclusion criteria and were included in the review. The citation searching process of checking references lists of relevant SLRs did not identify any further studies for inclusion. The study selection process is detailed in Figure 1.

Summary of Study Characteristics

Overall, the evidence base largely consisted of retrospective analyses of large administrative databases and registries. These sources are appropriate for estimating hospitalization-related utilization and costs at scale but may have limited clinical granularity (eg, incomplete LVEF detail, limited characterization of HF severity, and potential coding variation across sites and over time), which should be considered when interpreting cost-driver associations.

Characteristics of the included studies are presented in Table 2.27-65 Most studies reported data relating to HFmrEF/HFpEF as part of a broader HF study cohort rather than focusing exclusively on patients with HFmrEF/HFpEF. Definitions of HFmrEF and HFpEF varied. Eight studies (18%) reported data separately for individuals with HFmrEF and HFpEF,27-34 defined as an LVEF of 41% to 49% and an LVEF of 50% or more, respectively. Nine studies reported data for individuals with HFpEF only,6,7,9,10,35-39 defined as an LVEF of at least 50%; and 3 studies used a cutoff of an LVEF exceeding 40% to define HFpEF.40-42 Twelve studies identified individuals with HFpEF through International Statistical Classification of Diseases (ICD) codes with no explicit reference to LVEF thresholds,12,43-53 whereas the remaining studies either did not report any definitions of HFmrEF or HFpEF54-57 or used alternative thresholds (eg, LVEF ≥ 40%,58-60 ≥ 45%,8,61 > 50%,11,62 or ≥ 55%63).

The study populations were broadly similar with regard to age and sex. Among the studies that reported the age of individuals with HFmrEF/HFpEF, the median age ranged from 69.7 to 82.0 years. One study restricted its population to younger adults (age, 18-45 years) but did not report the mean or median age of those with HFmrEF/HFpEF.55 In terms of sex distribution of people with HFmrEF/HFpEF in the included studies, the proportion of females ranged from 45% to 66%, except for 1 study that used data from Veterans Affairs Medical Center and had just 2.3% female participation.61

The median study sample size was 42,874 (range, 71-4,496,394). Twenty-four (62%) of the included studies used data from population-based databases or registries such as the National Inpatient Sample (NIS) or the Get With The Guidelines-Heart Failure (GWTG-HF) registry, a performance improvement–based registry comprising patients hospitalized for HF in over 600 participating centers in the US.28,30,32,34,36,37,41,43-58,62 Six studies used data sources that were specific to localities smaller than the national level (eg, the Jackson Heart Study),27,29,33,35,39,42 whereas the remaining 7 were single-center studies.31,38,40,59-61,63

Across 10 studies (23%), Medicare was the primary payer for 54% to 85% of HFmrEF/HFpEF hospitalizations.28,32,36,37,39,41,47,48,52,53 The proportion of individuals whose primary payer was Medicaid ranged from 6% to 14%, whereas 3% to 26% of individuals were covered primarily by private insurance. The rest of the studies included specific payers (100% Medicare beneficiaries,58 Medicare Advantage or commercial insurance only,51 or commercial insurance only57) or did not report payer information. Where baseline medication was reported, over 50% of people hospitalized for HFmrEF/HFpEF were taking β-blockers (62%-77%) or diuretics (52%-71%) at the time of admission.12,29,35,39,42,57

Overall HFmrEF/HFpEF Hospitalization Costs

From the 2 studies reporting mean total costs associated with HFmrEF/HFpEF management—including hospitalization, outpatient, pharmacy, and emergency costs—hospitalization represented a primary cost driver. Total costs for HFmrEF/HFpEF (inflated to 2025 US$) ranged from $36,921 to $49,081 per PPPY, of which all-cause inpatient hospitalization costs made up almost half ($18,844-$20,975 PPPY).29,51 These estimates were derived from studies that may have limited generalizability; one relied on health maintenance organization data confined to the Pacific Northwest area,29 and the other was a cross-sectional study with a sample size of only 598 individuals,51 potentially reducing their representation of the wider HFmrEF/HFpEF population. Nevertheless, the Pacific Northwest study, which reported the estimates at the lower end of the range, is likely to be more reliable given its sample size of 14,086 individuals and longitudinal design. Among HF subtypes, patients with HFpEF had higher total costs PPPY than those with either HFmrEF or HFrEF ($42,25129-$49,08151 for HFpEF versus $36,92129 for HFmrEF and $34,649 and for HFrEF29).

In the 2 studies that reported data separately for index admissions and readmissions,48,58 readmissions were consistently associated with higher costs. The mean cost of index admissions for HFmrEF/HFpEF was $13,763 to$14,944,48,58 and the median cost of all-cause readmission was $21,371 to $28,615.48,58 The lower estimate of $21,371 may be an underestimate of the full costs of readmission; this study only included readmissions within 30 days,48 whereas the other included all readmissions within a year of index admission.58 The latter study also reported mean HF-specific hospitalization costs of $6296 PPPY for the first year following discharge, excluding index admission costs, compared to $22,319 PPPY for hospitalization for reasons other than HF.58

Four studies reported charges instead of or in addition to costs; the charge per admission ranged from $52,242 to $68,596.33,37,48,52 Two studies reported mean charges per admission ($60,82248 and $52,24237), and the other 2 reported median charges per admission ($57,99252 and $68,59633). The use of means in 2 studies and medians in the other 2 studies may help to explain the range of estimates; the approximations using medians may be more reliable, since they are less influenced by extreme outlier values. Three studies did not describe whether the charges reported included readmissions, and 1 study explicitly reported substantially higher charges for all-cause readmissions ($80,911) than for index HFmrEF/HFpEF admissions ($53,970).48 Additionally, this study reported costs and charges separately, demonstrating that charges were more than 3 times higher than costs for both index admissions (charges, $53,970; costs, $14,944) and readmissions (charges, $80,911; costs, $21,371).48 No other studies reported charges and costs separately.

Additionally, 1 study found that the average costs incurred between 30 days and 6 months following discharge ($18,497) were higher than the average costs of the initial admission ($14,971), likely reflecting the impact of hospital readmissions; however, the data source did not provide granular detail on numbers and costs of readmissions.58

HFmrEF/HFpEF Hospitalization Costs Associated With Comorbidities and Co-Occurring Conditions

Nine studies reported data on the relationship between costs and comorbidities or other co-occurring conditions,29,36,43,44,46,50,53,56,62 and 2 studies reported data on the relationship between co-occurring conditions and charges.37,54 In studies reporting data for patients with HFpEF only, there were higher costs associated with HFpEF plus other conditions than for people admitted with HFpEF and without those comorbidities. Total costs per HFpEF admission were significantly higher for individuals with HFpEF and cardiac arrest events, obstructive sleep apnea (OSA), left bundle branch block (LBBB), and pulmonary hypertension (PH) (Figure 2).36,46,50,53,62

The factors presented in Figure 2 represent heterogeneous clinical constructs, including chronic comorbid diseases (eg, OSA, pulmonary hypertension), an electrocardiographic conduction abnormality (LBBB), and acute in-hospital events (cardiac arrest). These factors should be interpreted primarily as markers of patient acuity and clinical complexity in administrative data rather than as isolated comorbidities that independently drive costs. Higher costs in these subgroups plausibly reflect greater management intensity and resource use, such as additional monitoring, diagnostic testing, higher-acuity unit care, procedure utilization, and complication.

Mean costs were reported for patients with and without OSA ($80,602 vs $73,223, respectively)46 and LBBB ($104,472 vs $77,464).50 Median costs were reported for those with and without PH ($24,261 vs $19,553)62 and in-hospital cardiac arrest events ($156,915 vs $50,526 in 1 study36 and $26,383 vs $10,784 in another53). There was insufficient detail on cost calculations in the publications to explain why 2 studies measuring median hospital costs for HFpEF with and without cardiac arrest events during hospitalization reported such different estimates. The study populations, data sources, and lengths of stay were similar, but the study reporting lower costs had a substantially higher inpatient mortality rate, which could have reduced the median total cost, since patients incur no further hospital costs after death.

Additionally, significantly higher costs were associated with admissions for people with HFpEF plus CKD (versus those with no CKD) and end-stage kidney disease (ESKD) (versus those with no ESKD). However, the study reporting this outcome did not provide all costs for each group—only the results of significance testing were reported.56

When charges were reported instead of costs, significantly higher fees were reported for individuals with HFpEF and severe obesity.54 The charges for individuals with polyvascular disease were higher than for those without, although this study did not report any statistical testing between the 2 groups.37 No significant differences were found for HFpEF hospitalization charges for individuals with HFpEF and COVID-19 or iron deficiency anemia.43,44

Multimorbidity was associated with higher costs than single comorbidities. Total PPPY costs associated with HFpEF plus both CKD and T2D were almost double the costs for HFpEF without either CKD or T2D ($62,310 vs $32,278); similar differences were seen for total PPPY costs associated with HFmrEF ($61,274 vs $29,259) (Figure 3).29 No other data on costs for people with HFmrEF and comorbidities were identified.

Readmission Rates

Eleven studies reported data on 30-day readmissions,30-32,38-40,47-49,51,60 none reported 60-day readmissions, and 2 studies reported 90-day readmissions.39,63 None of the studies reported the total number of hospitalizations per person or the average time to readmission.

All-Cause Readmissions at 30 Days

Approximately 20% of people hospitalized with HFmrEF/HFpEF were readmitted for any cause within 30 days; Figure 4 shows the ranges and median estimates stratified by LVEF thresholds (11 studies).30-32,38-40,47-49,51,60,64 Although 30-day readmission rates were broadly similar across most study populations, there were some outlying results, which are likely attributable to the type of index hospitalization. Among patients admitted following an emergency department visit, 30-day readmission rates were high (HFmrEF, 30%; HFpEF, 51.6%),31 whereas patients whose index hospitalization was to the intensive care unit had lower 30-day readmission rates (HFmrEF, 10.3%; HFpEF, 10.6%).38 One study reported that higher Charlson Comorbidity Index score, Medicaid insurance, longer index length of stay (LOS), and teaching hospital admissions were all significantly associated with higher rates of 30-day readmissions.48

HF-Specific Readmissions

Compared to all-cause readmissions, data for HF-specific readmissions were more limited. Table 3 presents data from 4 studies for HF-specific readmission rates at 30 days and, in 1 study, at both 30 and 90 days.27,30,32,39 Overall, HF-specific 30-day readmission rates ranged from 0% to 8.2% in individuals with HFmrEF (3 studies)27,30,32 and from 6.8% to 14.9% in individuals with HFpEF (4 studies).27,30,32,39 Omitting the 0% and 14.9% estimates reported in a study with denominators of just 5 individuals with HFmrEF and 94 individuals with HFpEF,27 the range of 30-day readmission rates was 6.8% to 8.2%, with little difference between HFmrEF and HFpEF or between urban and rural populations.30,32

As a proportion of all readmissions within 30 days, about a third were due to HF (32%-37% in 2 studies) (Table 3).30,32 This was consistent across HFpEF and HFmrEF subgroups and across urban and rural populations.

One study conducted on individuals with HFpEF reported a small increase in HF-specific readmission over time with a 30-day HF-specific readmission rate of 8% and a 90-day HF-specific readmission rate of 12.7%.39 However, the generalizability of this estimate is limited, as it was based on a single study, conducted in a single center, and studied in fewer than 2000 patients. Therefore, it may not be representative of the wider HFpEF population.

Longer-Term All-Cause Readmissions

Data were limited for 90-day all-cause readmission rates. One study involving 338 individuals with HFpEF (defined as LVEF ≥ 55%) assessed both cardiovascular and noncardiovascular hospital readmissions; a total 90-day readmission rate of 41.1% was reported.63 However, the generalizability of this estimate is limited, because the study only assessed data from a single hospital center. Additionally, a second study—also based on data from a single center—reported that 12.7% of 1965 patients with HFpEF (defined as LVEF ≥ 50%) were readmitted within 90 days.39 These 2 estimates were derived from small study samples for which slightly different inclusion criteria were applied; therefore, it is difficult to draw firm conclusions about the true risk of 90-day readmission in the HFmrEF/HFpEF population.

Due to the sparsity of data for 90-day readmissions, we also extracted data for readmission rates within longer-term time scales. From 3 studies, 32.9% to 67.5% of patients were readmitted within 1 year (Table 4).32,38,41 The variability in 1-year readmission rates is likely attributable to differences in study design and sample size. The study reporting lower rates of 1-year readmission was conducted in a single center with a sample size of 1895 (HFmrEF, 602 patients; HFpEF, 1293 patients),38 whereas the estimates for the other 2 studies are more reliable given their larger sample sizes (42,87432 and 79,895 individuals,41 respectively) and their use of a nationally representative data source (ie, the GWTG-HF registry). For studies reporting over 4 years of follow-up data, the proportion of HF-specific readmissions was 45% to 64%.28,35

Number of Hospitalizations per Person and Time From Diagnosis to Hospitalization

None of the studies explicitly reported the total number of admissions per person hospitalized with HFmrEF/HFpEF, but 1 study in 4975 individuals with HFpEF reported the number of people with at least 2 hospitalizations stratified by cause of hospitalization. The proportions with 2 or more hospitalizations for cardiovascular disease, HF, and CKD were 21.4%, 21.2%, and 15.5%, respectively.57 One study assessed time to readmission in 1036 Black patients with HFmrEF/HFpEF and reported a mean time to readmission of approximately 30 days.33 No studies reported on time from first hospitalization to subsequent hospitalizations.

One study reported that 20% to 28% of patients were hospitalized for HF within 3 years of receiving echocardiogram confirmation of HFpEF.42 However, no other studies reported time from diagnosis to HF hospitalization.

Hospital Length of Stay

Sixteen studies reported data related to LOS,28-32,34,36,38,44,46,48,53-56,62 although few studies explicitly reported mean or median LOS. Other LOS-related outcomes in the included studies included associations between LOS and comorbidities or readmission rates along with temporal trends of LOS.

The median hospital LOS for individuals with HFmrEF/HFpEF was 4 days (3 studies; Figure 5).28,32,38 Evidence from the 2 largest studies reporting a median length of stay of 4 days has high generalizability due to large sample sizes (85,648 and 42,874, respectively) and a population-based data source (GWTG-HF registry).28,32 Furthermore, 2 studies reported that over 25% of patients were admitted for a week or longer.31,34

In people with HFpEF, cardiac arrest events and comorbidities including OSA and PH were significantly associated with longer hospital LOS (Figure 6).36,46,53,59,62 Patients admitted to urban hospitals were significantly more likely to stay for at least 4 days compared to those admitted to rural hospitals.30 Additionally, regression analyses indicated significantly longer LOS in HFpEF patients with CKD, ESKD, severe obesity, or iron deficiency anemia versus those without these comorbidities.44,54,56

Multimorbidity was associated with longer hospital LOS than single comorbidities. Having CKD and T2D in addition to HFmrEF/HFpEF led to longer hospital LOS than did having HFmrEF/HFpEF with CKD, HFmrEF/HFpEF with T2D, or HFmrEF/HFpEF without CKD or T2D.29

Hospital LOS was linked to other cost drivers of hospitalizations in people with HFpEF. In a large study using 2017 data from the National Readmissions Database, longer hospital LOS for index HFpEF admissions was associated with higher rates of 30-day all-cause readmission.48 In another study of young adults aged 18 to 45 years who were hospitalized for HFpEF during 2004-2018, hospital LOS decreased along with a concomitant decrease in total inpatient costs. However, the study did not report any data on readmissions or total costs related to HFpEF hospitalizations or to discharge to long-term care facilities.55 None of the studies reported similar outcomes for people with HFmrEF.

Discussion

This comprehensive literature review identified a substantial body of evidence (37 included studies) to quantify the economic burden of hospitalization for HFmrEF/HFpEF in the US using various metrics and outcomes. Results from 2 studies showed that the mean total inpatient costs for individuals hospitalized with HFmrEF/HFpEF ranged from approximately $18,210 to $20,775 PPPY; another 2 studies demonstrated that all-cause readmission costs were approximately double the cost of index admission. Evidence from 11 studies indicated that about one-fifth of patients were readmitted for any cause within 30 days, with some evidence suggesting a higher 30-day readmission rate among those whose index admission was in the emergency department. Eleven studies reported evidence that comorbidities such as T2D and CKD were a key driver of costs, readmissions, and length of hospital stay. Given that the HFmrEF/HFpEF population is primarily covered by Medicare, this implies a considerable strain on federal tax funding. This strain is expected to increase over time as the burden of these conditions in an aging population grows and the prevalence of comorbidities such as hypertension and T2D increases.66

This review adds to the findings of a previous systematic literature review investigating HF hospitalization costs, which estimated a mean cost of $7860 to $10,551 (2019 US$) per HFpEF-specific inpatient episode.14 Our findings provide up-to-date estimates of annualized costs that account for outpatient, pharmacy, emergency, and readmission costs in addition to index admissions. We also demonstrate the cost burden of all-cause readmissions and the extent to which comorbidities drive HFmrEF/HFpEF hospitalization costs.

Since the introduction of the Hospital Readmission Reduction Program (HRRP), which aims to reduce readmission rates of Medicare beneficiaries by levying financial penalties on hospitals with excess 30-day readmissions for HF (among other conditions),1 all-cause readmissions among individuals with an index admission for HF may have decreased slightly from 2010 to 2015.67 However, data are not reported separately for those with an index admission for HFmrEF/HFpEF. All targeted conditions covered by the HRRP were associated with fewer all-cause readmissions, and the smallest reduction was noted among the HF group. Furthermore, whether the decrease is directly attributable to the HRRP or if other factors (eg, changes in how hospitals submit Medicare claims) have had a greater impact on readmission rates is uncertain. Nevertheless, reducing unnecessary HF readmissions remains a critical priority, as readmissions not only pose a significant burden on patients but also incur higher costs compared to index admissions, compounding the financial strain on health care systems. Targeted strategies to address readmissions are essential, particularly given their disproportionate economic impact relative to initial hospitalizations.

The rate of all-cause 30-day readmissions reported here emphasizes the need to improve care during index hospitalization and in the immediate period following discharge. Our finding that HF-specific readmissions account for at least one-third of all 30-day readmissions points to an unmet need for HF-specific interventions to reduce readmission rates. Furthermore, the number of people admitted to the hospital despite being treated with β-blockers or diuretics raises questions about the adequacy of existing treatments in preventing HF progression and suggests the need for additional therapeutic options.

New treatments and evolving guidelines can fill the unmet needs of patients with HFmrEF/HFpEF and may reduce the cost drivers of HFmrEF/HFpEF hospitalization. For instance, finerenone was recently approved by the FDA. It is the first nsMRA to demonstrate significant and clinically meaningful cardiovascular benefits in adults with HFmrEF/HFpEF.68 In a phase 3 trial involving individuals with an LVEF of at least 40%, finerenone reduced the risk of future HF events or cardiovascular death compared to placebo, with a greater effect size seen among those who initiated finerenone 7 days or fewer after a worsening HF event (rate ratio [RR], 0.74; 95% CI, 0.57-0.95) than in those initiating use of the drug between 7 days and 3 months after a worsening HF event (RR, 0.79; 95% CI, 0.64-0.97).22 This suggests that prompt use of finerenone may be beneficial. Incretin-based therapies, including GLP-1 receptor agonists (GLP-1 RAs) (eg, semaglutide, tirzepatide), also show promise for treating HFpEF in the absence of diabetes.69

HF guidelines have not been updated since the FDA approved GLP-1 RAs and finerenone for adult patients with HF with an LVEF of at least 40%. The most recent American College of Cardiology/American Heart Association/Heart Failure Society of America guideline (published in 2022) identified the efficacy and safety of nsMRAs as a future research priority.5 Given the newest finerenone indication and the growing scientific consensus supporting its use in people with HFmrEF/HFpEF and CKD and/or diabetes mellitus,70 the next guideline update likely will incorporate recommendations for finerenone in this HF subgroup.

In the interim, preventing or delaying index admissions for HFmrEF/HFpEF should be prioritized by ensuring better adherence to guideline-directed medical therapy (GDMT). Data for the HFmrEF/HFpEF population are lacking, yet there is evidence that GDMT is underused in people with HFrEF, with only 15% of eligible patients prescribed guideline-directed quadruple therapy.71 Expert consensus recommends simultaneous initiation of an SGLT2i and an nsMRA as a pillar of medical therapy to reduce morbidity and mortality in individuals with HFmrEF/HFpEF.21,71 Importantly, SGLT2i and nsMRA therapies have also demonstrated effectiveness in managing T2D and CKD72,73; these comorbidities are frequently seen in patients with HF and are associated with higher costs. In people with HFmrEF/HFpEF complicated by diabetes and CKD, greater adherence to these guideline-recommended therapies may improve clinical outcomes and reduce the substantial health care costs associated with managing these conditions.

Strengths and Limitations

The strengths of this review include a comprehensive search strategy and the availability of published data from nationally representative data sources. Many included studies drew on large, routinely collected data sources (eg, National Inpatient Sample, Nationwide Readmissions Database, and GWTG-HF), supporting the relevance of findings to managed care decision-makers and increasing the likely generalizability of estimates of hospitalization costs, readmissions, and length of stay in US practice. In addition, the direction of findings for several key economic drivers (notably readmissions and multimorbidity such as CKD and T2D) was generally consistent across multiple studies, which strengthens confidence in these drivers as contributors to overall cost burden. Nevertheless, limitations should be acknowledged. This review was comprehensive and systematic in its approach to study identification by employing prespecified eligibility criteria and including all studies meeting those criteria; however, a dual reviewer approach to screen references for inclusion was not used. Therefore, some relevant studies may have been missed. Furthermore, a formal assessment tool to appraise the methodological quality of the included studies was not used; however, the strength of evidence is summarized qualitatively based on study design, data source, sample size, and consistency of findings. Overall, the body of evidence was strongest for descriptive outcomes commonly captured in administrative and registry data (eg, all-cause 30-day readmission rates and inpatient length of stay) and for broad comparisons by high-prevalence comorbid disease categories (eg, CKD and diabetes). Evidence was weaker or sparse for outcomes requiring more granular longitudinal follow-up or consistent clinical adjudication (eg, HF-specific readmission rates, number of hospitalizations per person, time to subsequent hospitalization, and cost stratification by index vs subsequent admissions beyond a small number of studies). Additionally, the lack of consensus on defining HFmrEF and HFpEF in terms of LVEF thresholds introduces heterogeneity across the included studies that may affect the reliability of cost estimates. This heterogeneity complicates direct comparisons across studies, and it may influence the identification and quantification of cost drivers. For instance, differences in patient populations across studies could lead to over- or underestimates of the relative contributions of specific cost components (eg, length of hospital stay, readmission rates, or diagnostic procedures). This inconsistency could obscure patterns in cost drivers and reduce the precision of cost estimates for HFmrEF and HFpEF.

Another limitation is a potential overlap of data sources across studies, which could result in double-counting of certain patient populations. Moreover, there is limited or no evidence for some outcomes (eg, HF-specific readmissions, number of hospitalizations per person, and time to subsequent hospitalizations), which limits the full exploration of all potential cost drivers.

Conclusions

This comprehensive literature review highlights the substantial economic burden associated with HFmrEF/HFpEF hospitalizations in the US, with expenditures driven primarily by inpatient costs, readmissions, and comorbidities (eg, T2D, CKD). To optimize care and reduce readmissions—thereby mitigating the financial and clinical impact of HFmrEF/HFpEF—targeted interventions must be better understood and used.

Authorship Affiliation: Evidence Generation & Value Communications, Cencora (MG, KK, FS), Conshohocken, PA; Health Economics and Outcomes, Bayer (BH), Whippany, NJ; HEOR Strategy, Bayer (AK), Whippany, NJ; Washington Health Alliance & University of Washington (ABO), Seattle, WA.

Source of Funding: This work was funded by Bayer.

Author Disclosures: Dr Hocum and Dr Katta are employed by Bayer, and Dr Katta reports ownership of Bayer stock. Ms Gill, Dr Kistler, and Ms Stewart are employed by Cencora, which received funding from Bayer to complete this research. Ms Gill also reports ownership of Cencora stock. Dr Oliveira has no commercial financial relationships or affiliations to disclose.

Authorship Information: Concept and design (BH, AK, KK); acquisition of data (MG, BH, AK, FS); analysis and interpretation of data (MG, BH, AK, KK, ABO, FS); drafting of the manuscript (MG, BH, AK, ABO, FS); critical revision of the manuscript for important intellectual content (MG, BH, AK, KK, ABO, FS); statistical analysis (FS); obtaining funding (BH, AK); administrative, technical, or logistic support (BH, AK); supervision (BH, AK).

Acknowledgements: We would like to acknowledge Brittany Galloway, PharmD, of Cencora for her assistance in medical writing and strategic support and for her editorial review.

Address Correspondence to: Fiona Stewart, MSc. Avenida de la Suiza 1, 28821 Coslada, Madrid, Spain. Email: fi.stewart@cencora.com.

REFERENCES

  1. Hospital Readmissions Reduction Program. CMS. Accessed September 11, 2025. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp
  2. Bozkurt B, Ahmad T, Alexander K, et al. HF STATS 2024: Heart failure epidemiology and outcomes statistics an updated 2024 report from the Heart Failure Society of America. J Card Fail. 2025;31(1):66-116. doi:10.1016/j.cardfail.2024.07.001
  3. Martin SS, Aday AW, Allen NB, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Committee. 2025 Heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2025;151(8):e41-e660. doi:10.1161/cir.0000000000001303
  4. Racine M, Klovstad M. CVrg Market Strategies Heart Failure. 2024;3Q. For internal use.
  5. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263-e421. doi:10.1016/j.jacc.2021.12.012
  6. Baig M, Moafi-Madani M, Qureshi R, et al. Heart rate variability and the risk of heart failure and its subtypes in post-menopausal women: the Women’s Health Initiative study. PLoS One. 2022;17:e0276585. doi:10.1371/journal.pone.0276585
  7. Buckley LF, Claggett BL, Matsushita K, et al. Chronic kidney disease, heart failure, and adverse cardiac remodeling in older adults: the ARIC study. JACC Heart Fail. 2023;11(5):523-537. doi:10.1016/j.jchf.2023.01.029
  8. Echouffo-Tcheugui JB, Ogunmoroti O, Golden SH, et al. Glycemic markers and heart failure subtypes: the Multi-Ethnic Study of Atherosclerosis (MESA). J Card Fail. 2022;28(11):1593-1603. doi:10.1016/j.cardfail.2022.01.011
  9. Kamimura D, Yimer WK, Mentz RJ, et al. Cigarette smoking, smoking cessation, and heart failure subtypes: insights from the Jackson Heart Study. J Am Heart Assoc. 2024;13(23):e032921. doi:10.1161/JAHA.123.032921
  10. Kaze AD, Bertoni AG, Fox ER, et al. Diabetes, subclinical myocardial injury or stress, and risk of heart failure subtypes: the Jackson Heart Study. Diabetes Care. 2025;48(3):464-472. doi:10.2337/dc24-0654
  11. Park C, Ringel JB, Pinheiro LC, et al. Allostatic load and incident heart failure in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. BMC Cardiovasc Disord. 2023;23(1):340. doi:10.1186/s12872-023-03371-z
  12. Rao VN, Cyr DD, Wruck LM, et al. Electronic health record characterization and outcomes of heart failure with preserved ejection fraction. Am Heart J. 2023;263:1-14. doi:10.1016/j.ahj.2023.04.013
  13. Urbich M, Globe G, Pantiri K, et al. A systematic review of medical costs associated with heart failure in the USA (2014-2020). Pharmacoeconomics. 2020;38(11):1219-1236. doi:10.1007/s40273-020-00952-0
  14. Osenenko KM, Kuti E, Deighton AM, Pimple P, Szabo SM. Burden of hospitalization for heart failure in the United States: a systematic literature review. J Manag Care Spec Pharm. 2022;28(2):157-167. doi:10.18553/jmcp.2022.28.2.157
  15. Fonarow GC, Abraham WT, Albert NM, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med. 2008;168(8):847-54. doi:10.1001/archinte.168.8.847
  16. Clark KAA, Reinhardt SW, Chouairi F, et al. Trends in heart failure hospitalizations in the US from 2008 to 2018. J Card Fail.2022;28(2):171-180. doi:10.1016/j.cardfail.2021.08.020
  17. Nichols GA, Qiao Q, Deruaz-Luyet A, Kraus BJ. The clinical burden of newly diagnosed heart failure among patients with reduced, mildly reduced, and preserved ejection fraction. Int J Cardiol Heart Vasc. 2023;47:101182. doi:10.1016/j.ijcha.2023.101182
  18. Chang PP, Wruck LM, Shahar E, et al. Trends in hospitalizations and survival of acute decompensated heart failure in four US communities (2005-2014): ARIC Study Community Surveillance. Circulation. 2018;138(1):12-24. doi:10.1161/circulationaha 117.027551
  19. Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461. doi:10.1056/NEJMoa2107038
  20. Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098. doi:10.1056/NEJMoa2206286
  21. Shahid I, Khan MS, Butler J, Fonarow GC, Greene SJ. Initiation and sequencing of guideline-directed medical therapy for heart failure across the ejection fraction spectrum. Heart Fail Rev. 2025;30(3):515-523. doi:10.1007/s10741-025-10481-7
  22. Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2024;391(16):1475-1485. doi:10.1056/NEJMoa2407107
  23. Vardeny O, Vaduganathan M, Claggett BL, et al. Finerenone, serum potassium, and clinical outcomes in heart failure with mildly reduced or preserved ejection fraction. JAMA Cardiol. 2025;10(1):42-48. doi:10.1001/jamacardio.2024.4539
  24. Higgins J, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions, version 6.5. Updated August 2024. Accessed June 20, 2025. https://www.cochrane.org/handbook
  25. Economic filters. Canada’s Drug Agency. Accessed May 16, 2025. https://searchfilters.cda-amc.ca/list?q=&ps=20&p=1
  26. Economic studies search filter. SIGN. Accessed May 16, 2025. https://www.sign.ac.uk/using-our-guidelines/methodology/search-filters/
  27. Bracken D, Wagner-Dallas S, Branum D. Success in heart failure? An investigation of heart failure readmission rates and medication regimen optimization. Sr Care Pharm. 2024;39(3):113-122. doi:10.4140/TCP.n.2024.113
  28. Keshvani N, Shah S, Ayodele I, et al. Sex differences in long-term outcomes following acute heart failure hospitalization: findings from the Get With The Guidelines-Heart Failure registry. Eur J Heart Fail. 2023;25(9):1544-1554. doi:10.1002/ejhf.3003
  29. Nichols GA, Qiao Q, Linden S, Kraus BJ. Medical costs of chronic kidney disease and type 2 diabetes among newly diagnosed heart failure patients with reduced, mildly reduced, and preserved ejection fraction. Am J Cardiol. 2023;198:72-78. doi:10.1016/j.amjcard.2023.04.035
  30. Pierce JB, Ikeaba U, Peters AE, et al. Quality of care and outcomes among patients hospitalized for heart failure in rural vs urban us hospitals: the Get With The Guidelines-Heart Failure Registry. JAMA Cardiol. 2023;8(4):376-385. doi:10.1001/jamacardio.2023.0241
  31. Pokhrel Bhattarai S, Dzikowicz DJ, Carey MG. Association between serum albumin and the length of hospital stay among patients with acute heart failure. Biol Res Burs. 2025;27(1):37-46. doi:10.1177/10998004241262530
  32. Tang AB, Solomon N, Chiswell K, et al. Home-time, mortality, and readmissions among patients hospitalized with heart failure: a baseline prior to IMPLEMENT-HF. Circ Heart Fail. 2024;17(10):e011795. doi:10.1161/CIRCHEARTFAILURE.124.011795
  33. Williams TB, Crump A, Garza MY, et al. Care delivery team composition effect on hospitalization risk in African Americans with congestive heart failure. PloS One. 2023;18(6):e0286363. doi:10.1371/journal.pone.0286363
  34. Zheng J, Tisdale RL, Heidenreich PA, Sandhu AT. Disparities in hospital length of stay across race and ethnicity among patients with heart failure. Circ Heart Fail. 2022;15(11):e009362. doi:10.1161/CIRCHEARTFAILURE.121.009362
  35. Brann A, Miller J, Eshraghian E, Park JJ, Greenberg B. Global longitudinal strain predicts clinical outcomes in patients with heart failure with preserved ejection fraction. Eur J Heart Fail. 2023;25(10):1755-1765. doi:10.1002/ejhf.2947
  36. Garg M, Gupta M, Patel NN, Bansal K, Lam PH, Sheikh FH. Predictors and outcomes of sudden cardiac arrest in heart failure with preserved ejection fraction: a nationwide inpatient sample analysis. Am J Cardiol. 2023;206:277-284. doi:10.1016/j.amjcard.2023.08.145
  37. Gatuz MV, Abu-Fanne R, Abramov D, Mamas MA, Roguin A, Kobo O. Impact of polyvascular disease severity on acute heart failure prognosis. Heart Vessels. 2025;40(8):744-754. doi:10.1007/s00380-024-02496-1
  38. Jentzer JC, Reddy YN, Rosenbaum AN, Dunlay SM, Borlaug BA, Hollenberg SM. Outcomes and predictors of mortality among cardiac intensive care unit patients with heart failure. J Card Fail. 2022;28(7):1088-1099. doi:10.1016/j.cardfail.2022.02.015
  39. Park J, Zhong X, Babaie Sarijaloo F, Wokhlu A. Tailored risk assessment of 90-day acute heart failure readmission or all-cause death to heart failure with preserved versus reduced ejection fraction. Clin Cardiol. 2022;45(4):370-378. doi:10.1002/clc.23780
  40. Cohen A, Li T, Maybaum S, et al. Pulmonary congestion on lung ultrasound predicts increased risk of 30-day readmission in heart failure patients. J Ultrasound Med. 2023;42(8):1809-1818. doi:10.1002/jum.16202
  41. Patel RB, Greene SJ, Xu H, et al. Intersection of atrial fibrillation and heart failure with mildly reduced and preserved ejection fraction in >400 000 participants in the Get With The Guidelines-Heart Failure Registry. Eur J Heart Fail. 2023;25(1):63-73. doi:10.1002/ejhf.2729
  42. Peters AE, Clare RM, Chiswell K, et al. Implications of trial eligibility in patients with heart failure with mildly reduced or preserved ejection fraction. ESC Heart Fail. 2024;11(5):2813-2824. doi:10.1002/ehf2.14777
  43. Alharbi A, Alfatlawi H, Mohamed A, et al. Outcomes of heart failure related hospitalizations during the COVID-19 pandemic. Cureus. 2023;15(3):e36935. doi:10.7759/cureus.36935
  44. Alharbi A, Shah M, Bansal N, et al. Outcomes and complications of heart failure with iron deficiency anemia: a nationwide analysis. Hospital Pract (1995). 2024;52(3):84-90. doi:10.1080/21548331.2024.2337615
  45. Chandrupatla SR, Singh JA. Rheumatoid arthritis and the risk of 90-day readmission after hospitalization for heart failure. Semin Arthritis Rheum. 2025;73:152727. doi:10.1016/j.semarthrit.2025.152727
  46. Gill J, Wu C. In-hospital outcomes and arrhythmia burden in patients with obstructive sleep apnea and heart failure with preserved ejection fraction. J Innov Card Rhythm Manag. 2022;13(6):5033-5040. doi:10.19102/icrm.2022.130602
  47. Huang YYC, Chen L, Wright JD. Comparison of perioperative outcomes in heart failure patients with reduced versus preserved ejection fraction after noncardiac surgery. Ann Surg. 2022;275(4):807-815. doi:10.1097/SLA.0000000000004044
  48. Jha AK, Ojha CP, Krishnan AM, Paul TK. Thirty-day readmission in patients with heart failure with preserved ejection fraction: insights from the nationwide readmission database. World J Cardiol. 2022;14(9):473-482. doi:10.4330/wjc.v14.i9.473
  49. Kim MJ, Aseltine RH Jr, Tabtabai SR. Understanding the burden of 30-day readmission in patients with both primary and secondary diagnoses of heart failure: causes, timing, and impact of co-morbidities. Am J Cardiol. 2024;210:76-84. doi:10.1016/j.amjcard.2023.09.086
  50. Mathew D, Agarwal S, Sherif A. Impact of left bundle branch block on heart failure with preserved ejection fraction. Pacing Clin Electrophysiol. 2023;46(5):422-424. doi:10.1111/pace.14690
  51. Nguyen C, Bamber L, Willey VJ, Evers T, Power TP, Stephenson JJ. Patient perspectives on the burden of heart failure with preserved ejection fraction in a US commercially insured and Medicare Advantage population: a survey study. Patient Pref Adherence. 2023;17:1181-1196. doi:10.2147/PPA.S395242
  52. Reddy S, Kattamuri L, Dwivedi A, Mukherjee D, Deoker A. Association of left and right branch blocks with clinical outcomes in patients with heart failure with preserved ejection fraction. Int J Angiol. 2025;34(2):92-99. doi:10.1055/a-2516-2082
  53. Chouairi F, Miller PE, Loriaux DB, et al. Trends and outcomes in cardiac arrest among heart failure admissions. Am J Cardiol. 2023;194:93-101. doi:10.1016/j.amjcard.2023.01.012
  54. Aguilar-Gallardo JS, Romeo FJ, Bhatia K, Correa A, Mechanick JI, Contreras JP. Severe obesity and heart failure. Am J Cardiol. 2022;177:53-60. doi:10.1016/j.amjcard.2022.04.048
  55. Jain V, Minhas AMK, Khan SU, et al. Trends in HF hospitalizations among young adults in the United States from 2004 to 2018. JACC Heart Fail. 2022;10(5):350-362. doi:10.1016/j.jchf.2022.01.021
  56. Minhas AMK, Bhopalwala HM, Dewaswala N, et al. Association of chronic renal insufficiency with inhospital outcomes in primary heart failure hospitalizations (insights from the National Inpatient Sample 2004 to 2018). Am J Cardiol. 2023;202:41-49. doi:10.1016/j.amjcard.2023.05.063
  57. Morgen CS, Haase CL, Oral TK, Schnecke V, Varbo A, Borlaug BA. Obesity, cardiorenal comorbidities, and risk of hospitalization in patients with heart failure with preserved ejection fraction. Mayo Clin Proc. 2023;98(10):1458-1468. doi:10.1016/j.mayocp.2023.07.008
  58. Kittipibul V, Vaduganathan M, Ikeaba U, et al. Cause-specific health care costs following hospitalization for heart failure and cost offset with SGLT2i therapy. JACC Heart Fail. 2024;12(8):1409-1421. doi:10.1016/j.jchf.2024.04.003
  59. Majmundar M, Kansara T, Kumar A, et al. Right ventricular systolic pressure—non-invasive bedside predictor of mortality and readmission in heart failure with reduced and preserved ejection fraction hospitalization. Indian Heart J. 2022;74(4):314-321. doi:10.1016/j.ihj.2022.03.002
  60. Steverson AB, Marano PJ, Chen C, et al. Predictors of all-cause 30-day readmissions in patients with heart failure at an urban safety net hospital: the importance of social determinants of health and mental health. Am J Med Open. 2023;10:100060. doi:10.1016/j.ajmo.2023.100060
  61. Downey M, Gravely A, Westanmo A, Hubers S, Adabag S. Mortality and readmission risk in relation to QRS duration among patients hospitalized for heart failure with preserved ejection fraction.
    J Electrocardiol. 2022;74:109-113. doi:10.1016/j.jelectrocard.2022.08.009
  62. Wahadneh OA, Alitter Q, Raju A, et al. Prevalence and impact of pulmonary hypertension on acute decompensated heart failure with preserved ejection fraction hospitalizations: a five-year retrospective analysis. Curr Probl Cardiol. 2024;49(6):102537. doi:10.1016/j.cpcardiol.2024.102537
  63. Trochez RJ, Barrett JB, Shi Y, et al. Vulnerability to functional decline is associated with noncardiovascular cause of 90-day readmission in hospitalized patients with heart failure. J Hosp Med. 2024;19(5):386-393. doi:10.1002/jhm.13316
  64. Kim MJ, Tabtabai SR, Aseltine RH, Jr. Predictors of 30-day readmission in patients hospitalized with heart failure as a primary versus secondary diagnosis. Am J Cardiol. 2023;207:407-417. doi:10.1016/j.amjcard.2023.08.111
  65. Majmundar M, Kansara T, Park H, et al. Absolute lymphocyte count as a predictor of mortality and readmission in heart failure hospitalization. Int J Cardiol Heart Vasc. 2022;39:100981. doi:10.1016/j.ijcha.2022.100981
  66. Kazi DS, Elkind MSV, Deutsch A, et al; American Heart Association. Forecasting the economic burden of cardiovascular disease and stroke in the United States through 2050: a presidential advisory from the American Heart Association. Circulation. 2024;150(4):e89-e101. doi:10.1161/cir.0000000000001258
  67. Lu CH, Clark CM, Tober R, et al. Readmissions and costs among younger and older adults for targeted conditions during the enactment of the hospital readmission reduction program. BMC Health Serv Res. 2021;21(1):386. doi:10.1186/s12913-021-06399-z
  68. U.S. FDA approves KERENDIA (finerenone) to treat patients with heart failure with left ventricular ejection fraction ≥40% following priority review. New release. Bayer. July 14, 2025. Accessed August 29, 2025. https://www.bayer.com/en/us/news-stories/fda-approves-kerendia
  69. Desai AS, Vaduganathan M, Claggett BL, et al. Finerenone in patients with a recent worsening heart failure event: the FINEARTS-HF trial. J Am Coll Cardiol. 2025;85(2):106-116. doi:10.1016/j.jacc.2024.09.004
  70. Lala A, Beavers C, Blumer V, et al. The continuum of prevention and heart failure in cardiovascular medicine: a joint scientific statement from the Heart Failure Society of America and The American Society for Preventive Cardiology. J Card Fail. 2025;32(1):75-105. doi:10.1016/j.cardfail.2025.06.013
  71. Greene SJ, Ayodele I, Pierce JB, et al. Eligibility and projected benefits of rapid initiation of quadruple therapy for newly diagnosed heart failure. JACC Heart Fail. 2024;12(8):1365-1377. doi:10.1016/j.jchf.2024.03.001
  72. Ferreira JP, Oliveira AC, Vasques-Novoa F, et al. Mineralocorticoid receptor antagonist combined with SGLT2 inhibitor versus SGLT2 inhibitor alone in chronic kidney disease: a meta-analysis of randomized trials. Am J Nephrol. 2025;56(2):236-242. doi:10.1159/000541686
  73. Amornritvanich P, Anothaisintawee T, Attia J, McKay GJ, Thakkinstian A. Efficacy of mineralocorticoid receptor antagonists on kidney and cardiovascular outcomes in patients with chronic kidney disease: an umbrella review. Kidney Med. 2025;7(2):100943. doi:10.1016/j.xkme.2024.100943

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