Diabetes Effect on Outcomes in Heart Failure Patients from OPTIMIZE-HF
Diabetes Effect on Outcomes in Heart Failure Patients from 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 X 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.
Diabetes mellitus (DM) is a common comorbid condition of heart failure (HF), and the prevalence of HF among diabetic patients is 2 to 3 times that of age-matched controls. Among the selected group of patients enrolled in chronic systolic HF clinical trials, generally 20% to 30% have DM, with a similar observed percentage (28%) for patients with preserved systolic HF investigated in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM)-Preserved trial. Although these patients sometimes have worse long-term outcomes than their nondiabetic counterparts, analyses from several major clinical studies have shown that the reduction in HF mortality and morbidity observed in treatment with angiotensin-converting enzyme inhibitors (ACEI), aldosterone antagonists, and ß-blockers extends to diabetic patients.
Currently, little is known about the prevalence of DM and the effect of its presence on the characteristics, treatment, and outcomes in patients hospitalized for HF. In addition, very little is known about how well guideline-recommended therapies are being used in patients with HF with DM. Although ß-blockers are recommended by national guidelines for use in diabetic patients with HF, they have been underutilized in this population due to perceived negative metabolic effects. Analyses of large patient databases from all regions of the country are critical in providing insight into whether optimal evidence-based therapies are used in HF patients with DM.
Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) is a registry and performance-improvement program for patients hospitalized with HF. This analysis of the OPTIMIZE-HF patient registry data aims to document the prevalence of DM in patients hospitalized for HF; assess the associations between DM and the characteristics, quality of care, treatment, and outcomes in these patients; and improve the understanding of the influence of DM on treatment and outcomes in patients hospitalized for worsening HF with reduced or preserved systolic function.
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 X 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.
Diabetes mellitus (DM) is a common comorbid condition of heart failure (HF), and the prevalence of HF among diabetic patients is 2 to 3 times that of age-matched controls. Among the selected group of patients enrolled in chronic systolic HF clinical trials, generally 20% to 30% have DM, with a similar observed percentage (28%) for patients with preserved systolic HF investigated in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM)-Preserved trial. Although these patients sometimes have worse long-term outcomes than their nondiabetic counterparts, analyses from several major clinical studies have shown that the reduction in HF mortality and morbidity observed in treatment with angiotensin-converting enzyme inhibitors (ACEI), aldosterone antagonists, and ß-blockers extends to diabetic patients.
Currently, little is known about the prevalence of DM and the effect of its presence on the characteristics, treatment, and outcomes in patients hospitalized for HF. In addition, very little is known about how well guideline-recommended therapies are being used in patients with HF with DM. Although ß-blockers are recommended by national guidelines for use in diabetic patients with HF, they have been underutilized in this population due to perceived negative metabolic effects. Analyses of large patient databases from all regions of the country are critical in providing insight into whether optimal evidence-based therapies are used in HF patients with DM.
Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) is a registry and performance-improvement program for patients hospitalized with HF. This analysis of the OPTIMIZE-HF patient registry data aims to document the prevalence of DM in patients hospitalized for HF; assess the associations between DM and the characteristics, quality of care, treatment, and outcomes in these patients; and improve the understanding of the influence of DM on treatment and outcomes in patients hospitalized for worsening HF with reduced or preserved systolic function.
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