Rehospitalization for Heart Failure More Common in People With Diabetes

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Influence of diabetes on characteristics and outcomes in patients hospitalized with heart failure: a report from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF), by B.H. Greenberg and colleagues. Am Heart J 154: 277.e1-277.e8

What is the problem and what is known about it so far?

Type 2 diabetes is common in people with heart failure, as much as 2 or 3 times more common than in people without the disease. Although people with diabetes tend to fare worse from heart failure, and are more likely to die from cardiovascular disease (CVD, disease of the heart and blood vessels), research suggests that the chance of death from heart failure can be lowered by aggressively treating diabetes.

Why did the researchers do this particular study?

The researchers wanted to study the effects of diabetes, and its treatment, on people with heart failure.

Who was studied?

The study included 48,612 patients hospitalized with heart failure at 259 hospitals across the U.S. between March 2003 and December 2004. About 42% of the participants also had diabetes. Detailed follow-up information was obtained on 5,791 participants.

How was the study done?

The study was part of a larger evaluation of a medical toolkit for treating patients with heart failure, which included guidelines and tools for diagnosis and treatment, discharge checklists, educational materials, and instructions for patients.

Researchers gathered information about the medical condition of participants, including diagnostic and laboratory testing, drugs that were administered, quality of care, and outcomes.

What did the researchers find?

People with heart failure and diabetes tended to be younger than those without diabetes. Patients with diabetes and patients without diabetes generally received the same quality of care. There was no difference between the two groups in terms of the chance of dying while in the hospital or within 90 days of hospitalization. Patients in heart failure who have diabetes tended to stay in the hospital longer, by an average of almost half a day, than those without diabetes.

Patients with heart failure and diabetes are slightly more likely to be readmitted to the hospital than those without diabetes.

What were the limitations of the study?

The diagnosis of diabetes was based on review of medical records. Some cases of diabetes may have been missed. Similarly, information about drug therapy is from medical records, and may differ from what was actually taken by participants. The follow-up only included a sampling of participants, and was only conducted for 90 days. A longer follow-up with more participants could lead to different results.

What are the implications of the study?

People with heart failure who also have diabetes receive about the same quality of care as those without diabetes, and are also about as likely to die in the short term. However, people with diabetes are more likely to be rehospitalized. More information about both preventing diabetes and leading a heart-healthy lifestyle can be found at ADA’s “Make the Link page (http://diabetes.org/type-1-diabetes/well-being/heart-disease-and-stroke.jsp).