Background
Methods
Data source
Diagnosis and outcomes
Statistical analysis
Results
Baseline characteristics of all patients hospitalized with heart failure
Years | Heart failure patients with diabetes | Heart failure patients without diabetes | p value |
---|---|---|---|
N = 4,454,833 | N = 5,839,542 | ||
Age | |||
Mean (SD) | 71 (13) | 74 (15) | < 0.001 |
55–64 | 835,952 (18.8) | 680,201 (11.6) | < 0.001 |
65–74 | 1,176,474 (26.4) | 961,190 (16.5) | < 0.001 |
75–84 | 1,262,978 (28.4) | 1,659,077 (28.4) | < 0.001 |
> 84 | 645,476 (14.5) | 1,756,911 (30.1) | < 0.001 |
Gender | |||
Male | 2,221,535 (49.9) | 2,883,926 (49.4) | < 0.001 |
Female | 2,233,299 (50.1) | 2,955,617 (50.6) | < 0.001 |
Race | |||
White | 2,411,597 (63.1) | 3,508,611 (71.6) | < 0.001 |
Black | 823,586 (21.5) | 905,400 (18.5) | < 0.001 |
Hispanic | 386,624 (10.1) | 285,625 (5.8) | < 0.001 |
Asian | 76,382 (2) | 70,737 (1.4) | < 0.001 |
Native American | 25,370 (0.7) | 23,135 (0.5) | < 0.001 |
Other | 98,976 (2.6) | 103,419 (2.1) | < 0.001 |
Income | |||
Low | 1,546,020 (35.5) | 1,831,534 (32) | < 0.001 |
Low-mid | 1,162,972 (26.7) | 1,517,262 (26.6) | < 0.001 |
High-mid | 955,262 (21.9) | 1,289,277 (22.6) | < 0.001 |
High | 692,360 (15.9) | 1,076,649 (18.8) | < 0.001 |
Insurance | |||
Medicare | 3,288,992 (74) | 4,405,484 (75.6) | < 0.001 |
Medicaid | 389,579 (8.8) | 423,920 (7.3) | < 0.001 |
Private insurance | 556,756 (12.5) | 670,562 (11.5) | < 0.001 |
Self-pay | 122,096 (2.7) | 207,756 (3.6) | < 0.001 |
No charge | 12,877 (0.3) | 20,553 (0.4) | < 0.001 |
Other | 77,262 (1.7) | 100,639 (1.7) | < 0.001 |
Comorbidity | |||
Obesity | 944,309 (21.2) | 544,572 (9.3) | < 0.001 |
Hypertension | 3,150,266 (70.7) | 3,513,841 (60.2) | < 0.001 |
Smoking | 182,820 (20.3) | 250,695 (21.3) | < 0.001 |
Dyslipidemia | 399,759 (44.4) | 363,226 (30.8) | < 0.001 |
Past medical history | |||
PVD | 580,847 (13) | 531,775 (9.1) | < 0.001 |
Valvular heart disease | 14,116 (0.3) | 20,171 (0.3) | < 0.001 |
Renal failure | 1,955,821 (43.9) | 1,790,252 (30.7) | < 0.001 |
CAD | 474,232 (52.7) | 491,700 (41.7) | < 0.001 |
Hospital bedsize | |||
Small | 590,696 (14.8) | 804,526 (15.6) | < 0.001 |
Medium | 1,014,278 (25.5) | 1,302,158 (25.3) | < 0.001 |
Large | 2,379,740 (59.7) | 3,043,215 (59.1) | < 0.001 |
Hospital location | |||
Rural | 600,356 (15.1) | 798,911 (15.5) | < 0.001 |
Urban | 3,384,358 (84.9) | 4,350,988 (84.5) | < 0.001 |
Hospital region | |||
Northeast | 799,758 (20) | 1,091,333 (21.1) | < 0.001 |
Midwest | 945,667 (23.6) | 1,218,489 (23.6) | < 0.001 |
South | 1,696,082 (42.4) | 2,113,830 (40.9) | < 0.001 |
West | 562,024 (14) | 750,059 (14.5) | < 0.001 |
Charlson score | |||
0 | 8771 (1) | 274,150 (23.3) | < 0.001 |
1 | 164,377 (18.3) | 439,192 (37.3) | < 0.001 |
2 | 293,598 (32.6) | 284,231 (24.1) | < 0.001 |
≥ 3 | 432,676 (48.1) | 181,327 (15.4) | < 0.001 |
Temporal trend in cardiovascular outcomes
Years | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | p value (trend) |
---|---|---|---|---|---|---|---|---|---|---|---|
Total cases | 92,155 | 93,421 | 88,955 | 89,334 | 91,392 | 88,627 | 94,440 | 84,364 | 86,595 | 90,139 | |
Total cases (weighted) | 451,303 | 457,878 | 440,802 | 437,577 | 463,574 | 443,794 | 454,415 | 421,820 | 432,975 | 450,695 | |
Age | |||||||||||
Mean (SD) | 71 (13) | 71 (13) | 70 (13) | 71 (13) | 71 (13) | 71 (13) | 71 (13) | 71 (13) | 71 (13) | 70 (13) | < 0.001 |
< 55 | 51,418 (11.4) | 56,415 (12.3) | 55,205 (12.5) | 51,388 (11.7) | 56,058 (12.1) | 54,587 (12.3) | 53,532 (11.8) | 49,870 (11.8) | 51,475 (11.9) | 54,005 (12) | 0.142 |
55–64 | 83,505 (18.5) | 83,902 (18.3) | 82,415 (18.7) | 81,271 (18.6) | 86,024 (18.6) | 84,165 (19) | 85,404 (18.8) | 79,185 (18.8) | 82,835 (19.1) | 87,245 (19.4) | 0.831 |
65–74 | 121,147 (26.8) | 119,872 (26.2) | 115,374 (26.2) | 113,257 (25.9) | 122,185 (26.4) | 113,466 (25.6) | 117,768 (25.9) | 113,165 (26.8) | 117,215 (27.1) | 123,025 (27.3) | 0.512 |
75–84 | 136,971 (30.4) | 136,971 (29.7) | 136,971 (29.1) | 136,971 (29.4) | 136,971 (28.6) | 136,971 (28) | 136,971 (28) | 136,971 (27.1) | 136,971 (26.7) | 136,971 (26.5) | < 0.001 |
> 84 | 58,262 (12.9) | 61,909 (13.5) | 59,712 (13.5) | 63,027 (14.4) | 66,763 (14.4) | 67,259 (15.2) | 70,410 (15.5) | 65,305 (15.5) | 65,995 (15.2) | 66,835 (14.8) | < 0.001 |
Gender | |||||||||||
Male | 214,413 (47.5) | 219,516 (47.9) | 213,169 (48.4) | 215,705 (49.3) | 231,540 (49.9) | 223,763 (50.4) | 228,824 (50.4) | 215,770 (51.2) | 224,395 (51.8) | 234,440 (52) | 0.039 |
Race | |||||||||||
White | 221,523 (67.5) | 213,197 (62.1) | 203,853 (61.7) | 228,065 (64.4) | 254,629 (63.3) | 242,667 (61) | 258,389 (62.4) | 254,700 (63) | 261,615 (63.2) | 272,960 (62.9) | < 0.001 |
Afro-American | 56,755 (17.3) | 72,492 (21.1) | 73,490 (22.2) | 72,540 (20.5) | 82,702 (20.6) | 93,418 (23.5) | 96,260 (23.2) | 88,945 (22) | 90,635 (21.9) | 96,350 (22.2) | < 0.001 |
Hispanic | 35,584 (10.8) | 41,228 (12) | 35,271 (10.7) | 33,480 (9.5) | 40,553 (10.1) | 41,056 (10.3) | 39,291 (9.5) | 38,200 (9.5) | 40,135 (9.7) | 41,825 (9.6) | 0.192 |
Asian | 5252 (1.6) | 6683 (1.9) | 6722 (2) | 7011 (2) | 8172 (2) | 8413 (2.1) | 7043 (1.7) | 8600 (2.1) | 9265 (2.2) | 9220 (2.1) | < 0.001 |
Native American | 1444 (0.4) | 2690 (0.8) | 2654 (0.8) | 2932 (0.8) | 2266 (0.6) | 3245 (0.8) | 2534 (0.6) | 2745 (0.7) | 2380 (0.6) | 2480 (0.6) | 0.421 |
Other | 7517 (2.3) | 6953 (2) | 8550 (2.6) | 9884 (2.8) | 13,722 (3.4) | 9199 (2.3) | 10,837 (2.6) | 11,030 (2.7) | 10,110 (2.4) | 11,175 (2.6) | 0.211 |
Income | |||||||||||
Low | 152,120 (34.5) | 161,102 (36.1) | 158,946 (37) | 148,923 (34.7) | 154,810 (34.3) | 153,439 (35.5) | 158,141 (35.4) | 152,220 (36.8) | 149,030 (35.1) | 157,290 (35.6) | 0.245 |
Low-mid | 115,937 (26.3) | 115,598 (25.9) | 114,949 (26.7) | 120,171 (28) | 122,832 (27.2) | 114,916 (26.6) | 112,564 (25.2) | 106,315 (25.7) | 114,635 (27) | 125,055 (28.3) | 0.737 |
High-mid | 99,448 (22.5) | 96,232 (21.5) | 90,120 (21) | 90,288 (21) | 99,399 (22) | 95,572 (22.1) | 106,913 (23.9) | 90,670 (21.9) | 94,135 (22.2) | 92,485 (20.9) | 0.465 |
High | 73,698 (16.7) | 73,782 (16.5) | 65,890 (15.3) | 70,079 (16.3) | 74,387 (16.5) | 68,585 (15.9) | 68,900 (15.4) | 64,075 (15.5) | 66,235 (15.6) | 66,730 (15.1) | < 0.001 |
Insurance | |||||||||||
Medicare | 339,470 (75.3) | 340,195 (74.4) | 322,009 (73.2) | 318,351 (72.9) | 337,641 (73) | 321,259 (72.5) | 338,868 (74.8) | 316,165 (75.1) | 321,895 (74.5) | 333,140 (74) | 0.114 |
Medicaid | 37,973 (8.4) | 39,503 (8.6) | 37,675 (8.6) | 35,832 (8.2) | 40,500 (8.8) | 41,215 (9.3) | 37,925 (8.4) | 36,965 (8.8) | 38,105 (8.8) | 43,885 (9.7) | 0.439 |
Private insurance | 54,541 (12.1) | 56,644 (12.4) | 58,756 (13.3) | 62,486 (14.3) | 60,956 (13.2) | 58,183 (13.1) | 55,250 (12.2) | 47,290 (11.2) | 49,230 (11.4) | 53,420 (11.9) | 0.013 |
Self-pay | 11,800 (2.6) | 11,893 (2.6) | 12,216 (2.8) | 10,795 (2.5) | 14,342 (3.1) | 13,415 (3) | 11,966 (2.6) | 11,730 (2.8) | 13,245 (3.1) | 10,695 (2.4) | 0.733 |
No charge | 1335 (0.3) | 1322 (0.3) | 1649 (0.4) | 1252 (0.3) | 1312 (0.3) | 1595 (0.4) | 1231 (0.3) | 785 (0.2) | 1185 (0.3) | 1210 (0.3) | 0.013 |
Other | 5836 (1.3) | 7685 (1.7) | 7876 (1.8) | 8197 (1.9) | 7962 (1.7) | 7271 (1.6) | 7960 (1.8) | 8015 (1.9) | 8700 (2) | 7760 (1.7) | 0.392 |
Comorbidities | |||||||||||
Obesity | 57,547 (12.8) | 63,207 (13.8) | 69,197 (15.7) | 81,198 (18.6) | 94,613 (20.4) | 93,493 (21.1) | 113,684 (25) | 112,845 (26.8) | 122,010 (28.2) | 136,515 (30.3) | < 0.001 |
Hypertension | 283,958 (62.9) | 301,841 (65.9) | 294,820 (66.9) | 302,892 (69.2) | 328,905 (70.9) | 322,904 (72.8) | 334,731 (73.7) | 315,485 (74.8) | 325,500 (75.2) | 339,230 (75.3) | < 0.001 |
Smoking | 10,493 (11.4) | 12,063 (12.9) | 12,743 (14.3) | 13,579 (15.2) | 17,912 (19.6) | 18,806 (21.2) | 22,427 (23.7) | 21,639 (25.6) | 23,917 (27.6) | 29,241 (32.4) | < 0.001 |
Dyslipidemia | 27,927 (30.3) | 30,900 (33.1) | 32,665 (36.7) | 34,961 (39.1) | 40,487 (44.3) | 41,978 (47.4) | 47,623 (50.4) | 44,647 (52.9) | 47,535 (54.9) | 51,036 (56.6) | < 0.001 |
Past medical history | |||||||||||
PVD | 48,707 (10.8) | 49,859 (10.9) | 53,552 (12.1) | 56,681 (13) | 60,827 (13.1) | 58,766 (13.2) | 64,480 (14.2) | 60,420 (14.3) | 62,345 (14.4) | 65,210 (14.5) | < 0.001 |
Valvular heart disease | 1255 (0.3) | 1069 (0.2) | 1054 (0.2) | 1551 (0.4) | 1620 (0.3) | 1797 (0.4) | 1700 (0.4) | 1330 (0.3) | 1295 (0.3) | 1445 (0.3) | < 0.001 |
Chronic renal failure | 105,901 (23.5) | 159,894 (34.9) | 177,593 (40.3) | 182,052 (41.6) | 209,731 (45.2) | 211,265 (47.6) | 227,965 (50.2) | 215,795 (51.2) | 224,670 (51.9) | 240,955 (53.5) | < 0.001 |
CAD | 45,401 (49.3) | 45,814 (49) | 44,452 (50) | 45,768 (51.2) | 48,792 (53.4) | 47,164 (53.2) | 51,859 (54.9) | 47,050 (55.8) | 47,876 (55.3) | 50,056 (55.5) | < 0.001 |
Hospital bedsize | |||||||||||
Small | 58,557 (13) | 71,468 (15.7) | 60,571 (13.8) | 62,596 (14.3) | 62,260 (13.7) | 59,699 (13.6) | 61,698 (13.7) | 61,945 (14.7) | 63,245 (14.6) | 87,215 (19.4) | 0.375 |
Medium | 113,146 (25.1) | 116,965 (25.6) | 114,475 (26) | 102,065 (23.4) | 109,389 (24) | 102,419 (23.3) | 107,115 (23.8) | 112,585 (26.7) | 115,775 (26.7) | 133,490 (29.6) | 0.475 |
Large | 279,599 (62) | 267,985 (58.7) | 264,688 (60.2) | 272,328 (62.3) | 284,046 (62.3) | 278,084 (63.2) | 281,374 (62.5) | 247,290 (58.6) | 253,955 (58.7) | 229,990 (51) | 0.007 |
Hospital location | |||||||||||
Rural | 80,395 (17.8) | 76,812 (16.8) | 68,495 (15.6) | 71,227 (16.3) | 70,210 (15.4) | 66,769 (15.2) | 68,569 (15.2) | 60,530 (14.3) | 61,950 (14.3) | 55,795 (12.4) | < 0.001 |
Urban | 17.8 (370908) | 16.8 (379607) | 15.6 (371240) | 16.3 (365761) | 15.4 (385485) | 15.2 (373432) | 15.2 (381618) | 14.3 (361290) | 14.3 (371025) | 12.4 (394900) | < 0.001 |
Hospital region | |||||||||||
Northeast | 89,076 (19.7) | 95,572 (20.9) | 89,513 (20.3) | 82,908 (18.9) | 93,305 (20.1) | 89,591 (20.2) | 92,049 (20.3) | 83,705 (19.8) | 85,710 (19.8) | 87,405 (19.4) | 0.509 |
Midwest | 108,606 (24.1) | 107,624 (23.5) | 109,797 (24.9) | 99,843 (22.8) | 114,042 (24.6) | 106,040 (23.9) | 107,682 (23.7) | 98,000 (23.2) | 98,290 (22.7) | 104,350 (23.2) | 0.105 |
South | 193,290 (42.8) | 192,192 (42) | 180,971 (41.1) | 195,077 (44.6) | 190,717 (41.1) | 186,242 (42) | 191,788 (42.2) | 178,605 (42.3) | 185,890 (42.9) | 194,600 (43.2) | 0.064 |
West | 60,331 (13.4) | 62,490 (13.6) | 60,522 (13.7) | 59,749 (13.7) | 65,509 (14.1) | 61,922 (14) | 62,896 (13.8) | 61,510 (14.6) | 63,085 (14.6) | 64,340 (14.3) | 0.336 |
Charlson score | |||||||||||
0 | 1631 (1.8) | 1621 (1.7) | 1606 (1.8) | 1181 (1.3) | 696 (0.8) | 583 (0.7) | 507 (0.5) | 323 (0.4) | 362 (0.4) | 261 (0.3) | < 0.001 |
1 | 30,064 (32.6) | 30,630 (32.8) | 26,666 (30) | 18,809 (21.1) | 14,790 (16.2) | 11,920 (13.4) | 10,107 (10.7) | 7844 (9.3) | 7210 (8.3) | 6337 (7) | < 0.001 |
2 | 33,488 (36.3) | 34,445 (36.9) | 32,370 (36.4) | 31,523 (35.3) | 30,272 (33.1) | 28,697 (32.4) | 28,394 (30.1) | 24,658 (29.2) | 24,699 (28.5) | 25,052 (27.8) | < 0.001 |
≥ 3 | 26,972 (29.3) | 26,725 (28.6) | 28,313 (31.8) | 37,821 (42.3) | 45,634 (49.9) | 47,427 (53.5) | 55,432 (58.7) | 51,539 (61.1) | 54,324 (62.7) | 58,489 (64.9) | < 0.001 |
Years | OR | 95% CI | p value |
---|---|---|---|
Age | |||
< 55 | 1 | Referent group | – |
55–64 | 1.394 | 1.349 to 1.441 | < 0.001 |
65–74 | 2.117 | 2.054 to 2.182 | < 0.001 |
75–84 | 3.307 | 3.212 to 3.404 | < 0.001 |
> 84 | 5.16 | 5.01 to 5.316 | < 0.001 |
Gender | |||
Male | 1 | Referent group | – |
Female | 0.952 | 0.84 to 0.963 | < 0.001 |
Race | |||
White | 1 | Referent group | – |
Black | 0.477 | 0.468 to 0.487 | < 0.001 |
Hispanic | 0.688 | 0.673 to 0.705 | < 0.001 |
Asian | 0.947 | 0.907 to 0.989 | 0.015 |
Native American | 0.612 | 0.558 to 0.671 | < 0.001 |
Comorbidity | |||
Obesity | 0.603 | 0.593 to 0.613 | < 0.001 |
HTN | 0.678 | 0.670 to 0.686 | < 0.001 |
Dyslipidemia | 0.581 | 0.573 to 0.588 | < 0.001 |
Smoking | 0.596 | 0.586 to 0.607 | < 0.001 |
Past medical history | |||
PVD | 1.193 | 1.173 to 1.213 | < 0.001 |
Valvular heart disease | 2.839 | 2.657 to 3.033 | < 0.001 |
Chronic renal failure | 1.476 | 1.458 to 1.494 | < 0.001 |
CAD | 0.877 | 0.867 to 0.887 | < 0.001 |
Hospital bedsize | |||
Small | 1 | Referent group | – |
Medium | 0.928 | 0.910 to 0.946 | < 0.001 |
Large | 0.960 | 0.944 to 0.977 | < 0.001 |
Hospital location | |||
Rural | 1 | Referent group | – |
Urban | 0.898 | 0.884 to 0.913 | 0.001 |
Hospital region | |||
Northeast | 1 | Referent group | – |
Midwest | 0.889 | 0.873 to 0.905 | < 0.001 |
South | 0.520 | 0.496 to 0.545 | < 0.001 |
West | 0.536 | 0.512 to 0.561 | < 0.001 |