title: Temporal trends and factors associated with diabetes mellitus among patients hospitalized with heart failure: Findings from Get With The Guidelines-Heart Failure registry.
abstract: BACKGROUND
  The contribution of diabetes to the burden of heart failure (HF) remains largely undescribed. Assessing diabetes temporal trends among US patients hospitalized with HF and their relation with quality measures in real-world practice can help to define this burden.
  
  
  METHODS
  Using data from the Get With the Guidelines-Heart Failure registry, we assessed temporal trends in diabetes prevalence among patients with HF and in subgroups with reduced ejection fraction (HFrEF; EF < 40%), borderline EF (HFbEF; 40%≤EF <50%), or preserved EF (HFpEF; EF ≥ 50%), hospitalized between 2005 and 2015. Logistic regression was used to assess whether in-hospital outcomes and HF quality of care were related to trends.
  
  
  RESULTS
  Among 364,480 HF hospitalizations, 160,171 had diabetes (44.0% overall, 41.8% in HFrEF, 46.7% in HFbEF, 45.5% in HFpEF). There was a temporal increase in diabetes frequency in HF patients (43.2%-45.8%; Ptrend<.0001), including among those with HFrEF (42.0%-43.6%; Ptrend<.0001), HFbEF (46.0%-49.2%; Ptrend<.0001), or HFpEF (43.6%-46.8%, Ptrend<.0001). Diabetic patients had a longer hospital stay (adjusted odds ratio 1.14, 95% CI 1.12-1.16), but lower in-hospital mortality (adjusted odds ratio 0.93 [0.89-0.97]) compared with those without diabetes, with limited differences in quality measures. Temporal trends in diabetes were not associated with in-hospital mortality or length of stay. There were no temporal interactions of most HF quality measures with diabetes status.
  
  
  CONCLUSIONS
  Approximately 44% of hospitalized HF patients have diabetes, and this proportion has been increasing over the past 10years, particularly among those patients with new-onset HFpEF.
authors.affiliation: Brigham and Women's Hospital, and Harvard Medical School, Boston, MA. Electronic address: jechouffotcheugui@partners.org.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Echouffo-Tcheugui
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Haolin
authors.initials: H
authors.lastname: Xu
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: Cardiology Division, Stony Brook University, Stony Brook, NY.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Cardiology Division, Northwestern Feinberg School of Medicine, Chicago, IL.
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.affiliation: Brigham and Women's Hospital, and Harvard Medical School, Boston, MA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, and Stanford University, Stanford, CA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012959:Socioeconomic Factors; D013318:Stroke Volume; D014481:United States / Q000453:epidemiology