title: Diabetes, quality of care, and in-hospital outcomes in patients hospitalized with heart failure.
abstract: 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.
authors: University of Chicago Pritzker School of Medicine, Chicago, IL 60031, USA.
authors: John R
authors: JR
authors: Kapoor
authors: Gregg C
authors: GC
authors: Fonarow
authors: Xin
authors: X
authors: Zhao
authors: Roger
authors: R
authors: Kapoor
authors: Adrian F
authors: AF
authors: Hernandez
authors: Paul A
authors: PA
authors: Heidenreich
mesh_terms: D000368:Aged; D015897:Comorbidity / Q000639:trends; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D011446:Prospective Studies; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology