Background: Community trends of acute decompensated heart failure (ADHF) in diverse populations may differ by race and sex.

Methods: The ARIC study (Atherosclerosis Risk in Communities) sampled heart failure-related hospitalizations (≥55 years of age) in 4 US communities from 2005 to 2014 using International Classification of Diseases, Ninth Revision, Clinical Modification codes. ADHF hospitalizations were validated by standardized physician review and computer algorithm, yielding 40 173 events after accounting for sampling design (unweighted n=8746).

Results: Of the ADHF hospitalizations, 50% had reduced ejection fraction, and 39% had preserved EF (HFpEF). HF with reduced ejection fraction was more common in black men and white men, whereas HFpEF was most common in white women. Average age-adjusted rates of ADHF were highest in blacks (38.1 per 1000 black men, 30.5 per 1000 black women), with rates differing by HF type and sex. ADHF rates increased over the 10 years (average annual percentage change: black women +4.3%, black men +3.7%, white women +1.9%, white men +2.6%), mostly reflecting more acute HFpEF. Age-adjusted 28-day and 1-year case fatality proportions were ≈10% and 30%, respectively, similar across race-sex groups and HF types. Only blacks showed decreased 1-year mortality over time (average annual percentage change: black women –5.4%, black men –4.6%), with rates differing by HF type (average annual percentage change: black women HFpEF –7.1%, black men HF with reduced ejection fraction –4.7%).

Conclusions: Between 2005 and 2014, trends in ADHF hospitalizations increased in 4 US communities, primarily driven by acute HFpEF. Survival at 1 year was poor regardless of EF but improved over time for black women and black men.

背景：不同人群的急性失代偿性心力衰竭（ADHF）社区趋势可能因种族和性别而异。

方法： ARIC研究（社区中的动脉粥样硬化风险）使用国际疾病分类（第9版，临床修改）对2005年至2014年美国4个社区的心力衰竭相关住院（≥55岁）进行了抽样调查。ADHF住院治疗已通过标准化的医师审查和计算机算法进行了验证，考虑到抽样设计后产生了40173次事件（未加权n = 8746）。

结果：在ADHF住院治疗中，有50％的射血分数降低，而39％的射血分数得以保留（HFpEF）。射血分数降低的HF在黑人和白人中更为常见，而HFpEF在白人中最为常见。黑人的平均年龄校正后的ADHF发生率最高（每千名黑人男性为38.1，每千名黑人女性为30.5），并且因HF类型和性别而异。ADHF率在过去10年中有所增加（平均每年百分比变化：黑人女性+ 4.3％，黑人+ 3.7％，白人女性+ 1.9％，白人+ 2.6％），主要反映了更急性的HFpEF。经过年龄调整的28天和1年病死率分别为≈10％和30％，在不同种族的性别组和HF类型中相似。仅黑人显示出随时间推移而降低的1年死亡率（平均每年百分比变化：黑人女性–5.4％，黑人–4.6％），

结论： 2005年至2014年期间，美国4个社区的ADHF住院治疗趋势有所增加，主要是由急性HFpEF引起的。不论采用EF如何，1年生存率均较差，但随着时间的推移，黑人妇女和黑人男子的生存率有所提高。