Background: The impact of a history of congestive heart failure (CHF) on the outcomes of DKA and HHS hospitalizations is unknown, and current guidelines provide no clear recommendations for patients with CHF history.

Objective: To test the hypothesis that a history of CHF impacts the outcomes of DKA/HHS hospitalizations.

Design: Retrospective cohort study of DKA/HHS hospitalizations using Nationwide Inpatient Sample (NIS) database 2003 to 2014 (n= 1,793,983) and University Hospital cohort (n= 1,528).

Outcomes: All cause in-hospital mortality, acute respiratory failure events, length of stay and post discharge utilization of nursing home.

Results: In the NIS cohort, a history of CHF was present in 83,173 (4.6%) patients among DKA/HHS hospitalizations and was associated with higher adverse outcomes (mortality: 2.8% in CHF vs. 0.6% in no-CHF, adjusted odds ratio (AOR) = 1.5, 95% confidence interval (CI) 1.4 to 1.6; acute respiratory failure- 9.8% vs. 2.2%, AOR = 2.1, 95% CI 2.0 to 2.2). CHF history also predicted higher utilization of post discharge nursing home services (19.6% vs. 5.2%, AOR = 1.4, 95% CI 1.3 to 1.5) even after extensive adjustment for patient demographics, Elixhauser comorbidities and Charlson comorbidity index. In the University cohort, CHF history was present in 129 (8.4%) patients among 1,528 HGc hospitalizations and was associated with higher in-hospital complications (in-hospital mortality and acute respiratory failure [(13.2% vs. 5.2%, AOR = 2.1, 95% CI 1.2 to 3.7)] and higher utilization of post discharge nursing home (15.2% vs. 2.6%, AOR = 2.5, 95% CI 1.3 to 4.7) when compared with those without CHF. Mean length of stay was higher in patients with CHF history compared with no-CHF history in both datasets.

Conclusions: A history of CHF is an under-recognized risk factor for adverse outcomes of hospitalizations for hyperglycemic crises. Prospective studies are warranted to better understand and mitigate these differences in outcomes.

Disclosure

M. Agarwal: None. N. Jain: None. S. Kode: None. P.S. Podila: None. R.N. Khouzam: None. U.N. Ibebuogu: None. G. Reed: Other Relationship; Self; Translational Sciences. S. Dagogo-Jack: Board Member; Self; Jana Care Inc. Consultant; Self; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Sanofi-Aventis. Research Support; Self; AstraZeneca, Novo Nordisk Inc. Stock/Shareholder; Self; Dance Biopharm Holdings Inc.

© 2019 by the American Diabetes Association.
2019
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