A major healthcare and economic burden is attributable to heart failure (HF)-related hospitalizations. In the United States, the trends and characteristics of hospitalization for HF were reported from 2004 to 2018.

• Data from hospitalized adults ≥ 18 years with primary discharge diagnosis of HF were analyzed retrospectively from the National Inpatient Sample weighted data between 1 January 2004 and 31 December 2018.

• Since 2013, HF-related hospitalizations have been increasing across both genders and age groups, whereas inpatient mortality has been reducing.

• The highest risk of hospitalization for HF and the highest in-hospital mortality were observed in Blacks and Whites, respectively.

• Significant racial and geographic disparities associated with hospitalizations for HF are present.