Elsevier

American Heart Journal

Volume 182, December 2016, Pages 9-20
American Heart Journal

Clinical Investigation
Temporal trends and factors associated with diabetes mellitus among patients hospitalized with heart failure: Findings from Get With The Guidelines–Heart Failure registry

https://doi.org/10.1016/j.ahj.2016.07.025Get rights and content

Background

The contribution of diabetes to the burden of heart failure (HF) remains largely undescribed. Assessing diabetes temporal trends among US patients hospitalized with HF and their relation with quality measures in real-world practice can help to define this burden.

Methods

Using data from the Get With the Guidelines–Heart Failure registry, we assessed temporal trends in diabetes prevalence among patients with HF and in subgroups with reduced ejection fraction (HFrEF; EF < 40%), borderline EF (HFbEF; 40%  EF < 50%), or preserved EF (HFpEF; EF ≥ 50%), hospitalized between 2005 and 2015. Logistic regression was used to assess whether in-hospital outcomes and HF quality of care were related to trends.

Results

Among 364,480 HF hospitalizations, 160,171 had diabetes (44.0% overall, 41.8% in HFrEF, 46.7% in HFbEF, 45.5% in HFpEF). There was a temporal increase in diabetes frequency in HF patients (43.2%-45.8%; Ptrend < .0001), including among those with HFrEF (42.0%-43.6%; Ptrend < .0001), HFbEF (46.0%-49.2%; Ptrend < .0001), or HFpEF (43.6%-46.8%, Ptrend < .0001). Diabetic patients had a longer hospital stay (adjusted odds ratio 1.14, 95% CI 1.12-1.16), but lower in-hospital mortality (adjusted odds ratio 0.93 [0.89-0.97]) compared with those without diabetes, with limited differences in quality measures. Temporal trends in diabetes were not associated with in-hospital mortality or length of stay. There were no temporal interactions of most HF quality measures with diabetes status.

Conclusions

Approximately 44% of hospitalized HF patients have diabetes, and this proportion has been increasing over the past 10 years, particularly among those patients with new-onset HFpEF.

Section snippets

Data source

We used data from the GWTG-HF program database, which is an observational, prospective registry and quality improvement program, previously described.12 The registry enrolls adults hospitalized with new or worsening HF, from institutions from various US geographic regions, which include community hospitals and tertiary care referral centers that voluntarily take part in this program. These hospitals, in which personnel are trained to use standardized definitions, use a Web-based tool to

Patients characteristics

The study population consisted of 364,480 HF hospitalizations (166,541 [45.7%] with HFrEF, 46,545 [12.8%] with HFbEF, 151,394 [41.5%] with HFpEF). There were 160,171 (44.0% of all HF hospitalizations) with diabetes. The rates of diabetes were 41.8% in HFrEF, 46.7% in HFbEF, and 45.5% in HFpEF (P < .0001). The patient and hospital characteristics of those with and without diabetes on admission for HF are shown in Table I. Compared with patients without diabetes, those with diabetes were younger,

Discussion

In this large, multi-institutional, nationwide observational study, involving more than 350,000 patients admitted with HF in 462 hospitals participating in the GWTG-HF registry, we made several observations. First, an important fraction of HF hospitalizations (almost half) include diabetes as a comorbidity, with 1 in 3 patients with HF likely having diabetes as suggested by our analysis restricted patients with new-onset HF. Second, there were increasing temporal trends in diabetes among HF

Conclusion

Among patients hospitalized with HF, the prevalence of diabetes mellitus is 44% and has steadily increased over the past decade. Heart failure patients with diabetes had a longer hospital stay than did patients without diabetes, but experience similar care quality and in-hospital mortality. Future studies are warranted to explore ways to mitigate this mounting problem, which could exponentially worsen in the years to come, in the face of the growing obesity epidemic. With escalating health care

Sources of funding

The GWTG-HF program is provided by the American Heart Association. GWTG-HF has been funded in the past through support from Amgen, Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable.

Disclosures

Dr Fonarow reports significant consulting for Novartis and modest consulting for Amgen, Bayer, Gambro, Medtronic, and Janssen; Dr Fonarow is a member of the GWTG Steering Committee. Dr Fonarow holds the Eliot Corday Chair of Cardiovascular Medicine at UCLA and is also supported by the Ahmanson Foundation (Los Angeles, California).

Dr Deepak L. Bhatt discloses the following relationships—advisory board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; board of

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