No mortality risk increase for adults hospitalized with DKA, diastolic heart failure
Diastolic heart failure did not change the mortality risk for U.S. adults hospitalized with diabetic ketoacidosis in 2016 and 2017, according to a study published in Diabetes/Metabolism Research and Reviews.
“Comparing patients with and without diastolic heart failure, there was no statistically significant difference in inpatient mortality in DKA,” Hafeez Shaka, MD, an internal medicine specialist at the John H. Stronger, Jr. Hospital of Cook County, Chicago, and colleagues wrote. “The difference in crude mortality may be attributed mainly to age, as patients with diastolic heart failure were significantly older than those without diastolic heart failure. This is consistent with the increase in diastolic dysfunction and presumable secondary complications that can occur with normal aging.”
Researchers conducted a retrospective cohort study of adult hospitalizations with a primary diagnosis of DKA in the U.S. in 2016 and 2017. Data were collected from the National Inpatient Sample database. The primary outcome compared inpatient mortality in DKA based on the presence of diastolic heart failure. Researchers also examined the presence of sepsis, non-ST segment elevation myocardial infarction (NSTEMI), acute kidney failure, acute respiratory failure, deep vein thrombosis, pulmonary embolism, length of hospital stay and total hospital costs.
The study included 386,220 DKA hospitalizations, of which 1.5% included a secondary diagnosis of diastolic heart failure. There were 1,230 deaths in the study population, with 0.76% occurring in those with diastolic heart failure and 0.42% in adults without diastolic heart failure. After adjusting for confounders, there was no significant difference in mortality between those with and without diastolic heart failure.
In secondary analysis, adults with diastolic heart failure were more likely to have NSTEMI (adjusted OR = 1.31; 95% CI, 1.01-1.7; P = .045) and acute respiratory failure (aOR = 1.82; 95% CI, 1.38-2.4; P < .001). Those with diastolic heart failure also had a mean $6,500 more in total hospital costs (P = .0006) and spent a mean 0.7 more days in the hospital (P = .011) compared with adults without heart failure.
“The study revealed no difference in inpatient mortality in DKA with diastolic heart failure following adjustment for biodemographic, hospital characteristics and comorbidities,” the researchers wrote. “However, diastolic heart failure was associated with increased health care utilization costs and higher inpatient complications. Hence, appropriate monitoring for complications should be considered in hospitalized patients with DKA and diastolic heart failure.”