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).
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 chi2 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.
Greenberg
Barry H
BH
University of California-San Diego Medical Center, San Diego, CA 92103-8411, USA. bgreenberg@ucsd.edu
Abraham
William T
WT
Albert
Nancy M
NM
Chiswell
Karen
K
Clare
Robert
R
Stough
Wendy Gattis
WG
Gheorghiade
Mihai
M
O'Connor
Christopher M
CM
Sun
Jie Lena
JL
Yancy
Clyde W
CW
Young
James B
JB
Fonarow
Gregg C
GC
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012042:Registries; D014481:United States / Q000453:epidemiology