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.


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.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at