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Type 2 diabetes confers greater risk for subsequent CV-related hospitalization

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February 3, 2018

Patients hospitalized for a cardiovascular event have a nearly 20% higher risk for a subsequent CV hospitalization if they have type 2 diabetes vs. similar patients without type 2 diabetes, with the highest risk observed among patients aged 35 to 44 years, according to findings published in Current Medical Research and Opinion.

In a retrospective study, Anna D. Coutinho, PhD, of Xcenda LLC in Palm Harbor, Florida, and colleagues analyzed electronic medical records data from adult patients in the IMS LifeLink PharMetrics Plus claims database who had been hospitalized for a CV event between July 1, 2011, and June 30, 2014 (index period; n = 316,207). The pre-index period was defined as the 1 year preceding the index date and was used to identify patients with comorbid type 2 diabetes (23% of the cohort). The post-index period was defined as the duration of the index event and the postdischarge period and was used to assess outcomes. Primary outcome was subsequent CV hospitalization, including hospitalizations that occurred after discharge from the index hospitalization. Patients were stratified by sex and six age groups: aged 18 to 34 years, aged 35 to 44 years, aged 45 to 54 years, aged 55 to 64 years, aged 65 to 74 years and aged at least 75 years. Researchers also assessed health care resource use, defined as length of stay per subsequent hospitalization, bed-days per patient per month, number of all-cause and CV-related visits per patient per month by setting of care, and related health care costs, computed using paid amounts on claims after adjustment to 2015 U.S. dollars.

Within the cohort, 1.7% of patients died during the index hospitalization; researchers assessed outcomes for 310,926 patients followed for a mean period of 19 months. During follow-up, 20% of patients with type 2 diabetes had a subsequent CV hospitalization, whereas 16% of patients without diabetes were admitted with a subsequent CV hospitalization, for an incidence rate of 16.7 vs. 11.4 per 100 patient-years, respectively. Researchers found that, compared with patients without type 2 diabetes, patients in the cohort with type 2 diabetes were more likely to have an index hospitalization with a revascularization procedure (25.9% vs. 19.8%) or a discharge diagnosis of heart failure (16.3% vs. 9.3%).

After adjustment, patients with type 2 diabetes had a 19% increased risk for subsequent hospitalization for a CV event vs. patients without diabetes (adjusted OR = 1.19; 95% CI, 1.16-1.21).

The incidence rate of subsequent hospitalizations for a CV event was higher for patients with type 2 diabetes across all age groups, apart from patients aged 18 to 34 years. The difference in risk was highest for adults aged 35 to 44 years (HR = 1.3; 95% CI, 1.2-1.5) vs. those aged at least 75 years (HR = 1.1; 95% CI, 1.1-1.2). There were no between-sex differences in hospitalization trends.

Researchers also found that subsequent CV-related hospitalizations during the postdischarge period were longer among patients with type 2 diabetes vs. those without diabetes, (mean, 6 days vs. 5.6 days), as were all-cause hospitalizations (mean, 6.7 days vs. 6.3 days; P < .001 for all). Patients with type 2 diabetes also incurred higher health care costs during the postdischarge period compared with patients without diabetes, both for all-cause admissions (mean, $749 per patient per month) and CV-related admissions (mean, $250 per patient per month).

“These higher costs during postdischarge period were mainly driven by medical costs, which constituted 74.1% of the all-cause cause and 98.9% of total CV-related costs,” the researchers wrote. – by Regina Schaffer

Disclosures: Boehringer Ingelheim funded this study. Coutinho reports she is an employee of Xcenda, which has received research funding from Boehringer Ingelheim. Please see the study for the other authors’ relevant financial disclosures.