Elsevier

American Heart Journal

Volume 154, Issue 2, August 2007, Pages 277.e1-277.e8
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Influence of diabetes on characteristics and outcomes in patients hospitalized with heart failure: A report from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)

https://doi.org/10.1016/j.ahj.2007.05.001Get rights and content

Background

Diabetes, a common comorbidity in patients with heart failure (HF), is associated with worse long-term outcomes in patients with HF due to systolic dysfunction. Whether diabetes mellitus (DM) influences characteristics and outcomes in patients hospitalized with HF has not been well studied.

Methods

The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure is a patient registry and performance-improvement program for patients hospitalized with HF that included a prespecified 10% subgroup with 60- to 90-day follow-up data. Data were analyzed as DM compared with no DM. Pearson χ2 test for categorical variables and t test for continuous variables were used, as was a multivariable analysis that included a stepwise Cox proportional hazard model.

Results

Among 48,612 patients from 259 hospitals, 42% had DM. Heart failure patients with DM tended to be younger, with greater likelihood of ischemic etiology, and higher serum creatinine levels. Heart failure patients with DM received quality care measures to a similar degree, with a few modest exceptions. No differences in in-hospital mortality were observed, but HF patients with DM experienced modestly longer length of stay (5.9 vs 5.5 days for nondiabetic patients; P < .0001). In the 5791 patients in the follow-up cohort, patients with DM (n = 2464) had similar postdischarge mortality but increased all-cause rehospitalization (31.5% vs 28.2% for nondiabetic patients; P = .006). Multivariable analysis showed that DM was not an independent predictor of in-hospital (odds ratio, 1.00; 95% confidence interval, 0.88-1.14; P = .99) or follow-up mortality (hazard ratio, 1.08; 95% confidence interval, 0.87-1.35; P = .48).

Conclusions

The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure data reveal a high prevalence of DM in patients hospitalized with HF. Heat failure patients with DM received similar quality of care and experienced similar short-term mortality compared with patients without DM but had higher risk of rehospitalization.

Section snippets

Methods

The OPTIMIZE-HF was a comprehensive hospital-based registry and process-of-case improvement program designed to provide optimal medical care and education to patients hospitalized for HF. The OPTIMIZE-HF program has been described in detail elsewhere17, 18, 19 and will be briefly summarized below.

Patient comparison

This analysis included 48,612 patients at 259 hospitals, with follow-up data from 5791 patients. Among patients hospitalized for HF, 42% had diabetes (n = 20,162). Of these patients with DM, 40% were treated with insulin (n = 8058). The overall registry population was elderly, with a mean age of 73.2 years, and patients with DM were slightly younger than their nondiabetic counterparts (71.5 ± 12.2 vs 74.4 ± 15.0 years; P < .0001). Diabetic patients were more likely to have an ischemic etiology,

Discussion

This analysis from OPTIMIZE-HF demonstrates that a very high prevalence of DM exists among hospitalized patients with HF, with 42% of those enrolled having DM documented. A prevalence similar to that of the current study has also been observed in the Acute Decompensated Heart Failure National Registry, which showed that 44% of hospitalized patients with HF have DM.20 In the Enhanced Feedback for Effective Cardiac Treatment study of 4031 community-based patients presenting with new onset HF at

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    The OPTIMIZE-HF registry and this study were supported by GlaxoSmithKline, Philadelphia, PA.

    The OPTIMIZE-HF registry is registered: www.clinicaltrials.gov, study number NCT00344513.

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