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This study used data from the National Hospital Discharge Survey to examine secular trends and regional variation in hospitalization rates for congestive heart failure. The hospitalization rate for congestive heart failure rose significantly between 1995 and 2004 for adults aged 35 to 64 years. This trend was particularly marked in the West region (from 10.3 per 10,000 population in 1995 to 17.0 per 10,000 population in 2004; P<.001) and the South region (from 21.9 per 10,000 population in 1995 to 27.6 per 10,000 population in 2004; P<.001). The regional variations for congestive heart failure hospitalization among adults aged 35 to 64 years were associated with primary care physicians per 10,000 population, regional income level, and the proportion of Medicare payment.