Clinical InvestigationCongestive Heart FailureDiabetes, quality of care, and in-hospital outcomes in patients hospitalized with heart failure
Section snippets
Data collection
The GWTG-HF program is a national, prospective, observational, and ongoing voluntary data collection and continuous quality improvement initiative.13, 14 Hospitalized adults are enrolled in the registry with an episode of new or worsening HF as the primary reason for admission or with significant HF symptoms that developed during hospitalization in which HF was the primary discharge diagnosis. Hospitals from all census regions of the United States, including teaching and nonteaching, rural and
Baseline characteristics
The total study cohort consisted of 133,971 patients hospitalized with a diagnosis of HF from 431 hospitals, of which 61,318 patients (45.8%) had documented reduced LVEF, and 63,888 patients (47.7%) had preserved LVEF. There were 54,352 patients (40.6%) documented to have a medical history of diabetes or a new diagnosis of diabetes. Of the patients with diabetes, 46.6% were treated with insulin before hospitalization. The baseline characteristics of the overall population stratified by these 2
Discussion
This analysis from GWTG-HF demonstrates, with few exceptions, that the application of evidence-based care was similar whether or not a patient had diabetes in this large contemporary cohort of patients hospitalized with HF throughout the United States. Use of ACEI/ARB and β-blockers in eligible patients at hospital discharge was high, and there were no differences based on comorbid diabetes. Some differences in care were seen in HF patients based on comorbid diabetes. Specifically, when
Conclusions
This study using data from the GWTG-HF quality program demonstrates a high prevalence of diabetes among patients hospitalized with HF. With few exceptions, the application of evidence-based care was similar whether or not a patient with HF had diabetes in this large contemporary cohort of patients. Risk-adjusted in-hospital mortality was similar in the presence of diabetes, yet risk-adjusted hospital LOS was longer among HF patients with diabetes. These findings provide additional support for
Disclosures
John Kapoor, Roger Kapoor, and Xin Zhao have no conflicts of interest. Adrian Hernandez was supported by Research Johnson & Johnson, Proventys, and Amylin; Paul Heidenreich received a grant from Medtronic. Gregg Fonarow has received funding from Research National Heart, Lung, and Blood Institute and a consultant of Novartis, Medtronic, and Scios.
Program disclosure: GWTG-HF program is provided by the American Heart Association. The GWTG-HF program is currently supported in part by Medtronic,
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Cited by (20)
Diabetes and heart failure notions from epidemiology including patterns in low-, middle- and high-income countries
2021, Diabetes Research and Clinical PracticeCitation Excerpt :It is likely that an OGTT will disclose a higher proportion of dysglycaemia also in HF, previous studies indicate that as many as two thirds of a HF patients, will be diagnosed with either IGT or previously undetected diabetes as discussed above. [73–74] Diabetes and HF aggravates the prognosis of each other as shown in observational investigations of selected populations, [42,66,78,83–85] as well as in several randomized HF trials. [72,76,84,86–87] This is independent of HF etiology and whether the HF is with preserved or reduced EF (Fig. 4). [76,88]
Change in admission blood glucose from chronic glycemic status in acute heart failure hospitalization and 30-day outcomes: A retrospective analysis
2020, International Journal of CardiologyCitation Excerpt :Diabetes is a co-morbidity in 41–44% of patients enrolled in acute heart failure (AHF) hospital admission registries [1–3].
Glycated Hemoglobin and Outcomes of Heart Failure (from Get With the Guidelines-Heart Failure)
2019, American Journal of CardiologyTemporal trends and factors associated with diabetes mellitus among patients hospitalized with heart failure: Findings from Get With The Guidelines–Heart Failure registry
2016, American Heart JournalCitation Excerpt :However, these studies were either restricted to certain age groups (>65 years, for example),15 or smaller in size,15-17 or covered more distant periods and thus do not reflect the current and full extent of the burden of diabetes as an HF comorbidity. Also, our findings of a longer hospital stay among patients with diabetes compared with those without diabetes, but of similar in-hospital mortality, are similar to reports from previous investigations.10,11 Our findings have several important implications for clinical practice, as they highlight potential significant gaps in the contemporary clinical practice with respect to concurrent management of diabetes and HF, which presents unique challenges in a context of the emergence of new diabetes treatments with a potential impact on the occurrence and outcomes of HF.
Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure
2015, JACC: Heart FailureGlycemic Variability and Glycemic Control in the Acutely Ill Cardiac Patient
2012, Heart Failure ClinicsCitation Excerpt :For the estimated 25.6 million Americans more than the age of 20 years who have diabetes, the risk of having a myocardial infarction or congestive heart failure is about twice as great as those without diabetes.1,2 In addition, it is estimated that 20% to 30% of patients admitted to the hospital with acute coronary syndrome, and 20% to 40% of those admitted with congestive heart failure exacerbation, have diabetes.3–5 Diabetes is believed to be an independent risk factor for heart failure.6–8
James L Januzzi, MD, served as guest editor for this article.