Temporal trends and factors associated with diabetes mellitus among patients hospitalized with heart failure: Findings from Get With The Guidelines-Heart Failure registry
Temporal trends and factors associated with diabetes mellitus among patients hospitalized with heart failure: Findings from Get With The Guidelines-Heart Failure registry
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DOI：
10.1016/j.ahj.2016.07.025
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发表时间：
2016-12-01
影响因子：
4.8
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
Echouffo-Tcheugui, Justin B.;Xu, Haolin;Fonarow, Gregg C.
背景糖尿病对心力衰竭（HF）负担的贡献在很大程度上尚未得到描述。评估美国HF住院患者中糖尿病的时间趋势及其与现实世界实践中质量指标的关系可以帮助定义这种负担。方法使用来自指南-心力衰竭登记处的数据，我们评估了HF患者和射血分数降低亚组中糖尿病患病率的时间趋势（HFrEF; EF < 40%），临界EF（HFbEF; 40% = 50%），2005年至2015年期间住院。结果在364，480例HF住院患者中，有160，171例患有糖尿病（占44.0%，HFrEF为41.8%，HFbEF为46.7%，HFpEF为45.5%）。HF患者中糖尿病发生率随时间增加（43.2%-45.8%; P趋势< .0001），包括HFrEF（42.0%-43.6%; P趋势< .0001）、HFbEF（46.0%-49.2%; P趋势< .0001）或HFpEF（43.6%-46.8%，P趋势< .0001）患者。与非糖尿病患者相比，糖尿病患者的住院时间更长（校正比值比1.14，95%CI 1.12-1.16），但住院死亡率更低（校正比值比0.93 [0.89-0.97]），质量指标差异有限。糖尿病的时间趋势与住院死亡率或住院时间无关。有没有时间的相互作用，大多数HF质量措施与糖尿病status.Conclusions约44%的住院HF患者有糖尿病，这一比例一直在增加，在过去的10年中，特别是新发HFpEF的患者。
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% = 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%; P-trend < .0001), including among those with HFrEF (42.0%-43.6%; P-trend < .0001), HFbEF (46.0%-49.2%; P-trend < .0001), or HFpEF (43.6%46.8%, P-trend < .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 10 years, particularly among those patients with new-onset HFpEF.