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The present study analyzed the evolution of hospitalizations for ambulatory care-sensitive conditions (ACSC) in Brazil from 2000 to 2022, highlighting national trends and the impact COVID-19 through an ecological and longitudinal study, using data from the Hospital Information System (SIM) of the Brazilian Unified Health System (SUS). This study analyzed ACSC rates and their proportion of total hospitalizations, considering an estimated population, regional and state distribution, and age ranges. A total of 56,308,152 ACSCs were recorded during the period, corresponding to 20.8% of all hospitalizations in the country. A decrease was found in ACSC rates per 10,000 inhabitants and in the proportion of total hospitalizations, with stagnation observed between 2015-2019. Most states and regions saw a decline, with the largest decreases found in the North, Northeast, and Midwest regions. Regarding age ranges, a decrease in ACSC was observed during the period, with an increase during the pandemic among children under 5 years of age and older adults, along with changes in cause patterns. During the pandemic, rates decreased between 2020-2021, only to rise again in 2022. The importance of policies ensuring comprehensive and continuous access to the Family Health Strategy (FHS) in Brazil is highlighted, especially for vulnerable groups, as is the need for continuous investments.