Elsevier

American Heart Journal

Volume 162, Issue 3, September 2011, Pages 480-486.e3
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Diabetes, quality of care, and in-hospital outcomes in patients hospitalized with heart failure

https://doi.org/10.1016/j.ahj.2011.06.008Get rights and content

Background

Diabetes mellitus is frequently comorbid with heart failure (HF). It is unclear if comorbid diabetes is associated with quality of care and in-hospital mortality.

Methods

We analyzed 133,971 HF admissions from 431 hospitals between January 2005 and January 2010 comparing patients with and without diabetes.

Results

There were 54,352 (41%) patients hospitalized with HF with a history or newly diagnosed diabetes. After adjustment, patients with diabetes were as likely as patients without diabetes to appropriately receive the composite of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and β-blockers (odds ratio [OR] 0.99, 95% CI 0.94-1.04), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (OR 0.98, 95% CI 0.92-1.05), evidence-based β-blockers (OR 1.04, 95% CI 0.98-1.1), and hydralazine/nitrates (OR 1.09, 95% CI 0.99-1.2). However, patients with diabetes were less likely to receive smoking cessation counseling (OR 0.89, 95% CI 0.81-0.98) and blood pressure control (OR 0.81, 95% CI 0.78-0.84) and to attain the all-or-none composite measure (OR 0.96, 95% CI 0.93-0.99). Patients with diabetes were more likely to receive an aldosterone antagonist for reduced left ventricular ejection fraction (OR 1.05, 95% CI 1.00-1.11), lipid-lowering agent (OR 1.33, 95% CI 1.26-1.41), and influenza vaccination (OR 1.05, 95% CI 1.01-1.09). Diabetes was independently associated with longer hospital stay but not within-hospital mortality.

Conclusions

With few exceptions, the application of evidence-based care and in-hospital outcomes were similar whether or not diabetes was present in this large contemporary cohort of patients hospitalized with HF.

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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    James L Januzzi, MD, served as guest editor for this article.

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