Poster Presentation The Annual Scientific Meeting of the Australian Diabetes Society and the Australian Diabetes Educators Association 2013

"People with diabetes admitted for acute heart failure have prolonged hospital stay and under-recognised diastolic dysfunction" (#347)

Avinash Suryawanshi 1 , David Celermajer 2 , Kirtan Ganda 3 , Stephen Twigg 4
  1. Advanced Trainee in Endocrinology, Concord Hospital, Sydney, NSW, Australia
  2. Scandrett Professor of Cardiology, University of Sydney, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  3. Consultant Endocrinologist, Concord Hospital, Sydney, NSW, Australia
  4. Professor in Medicine, University of Sydney, Head, Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

Background: Diabetes is a common morbidity in patients with heart failure (HF) and it presents with HF subtypes including diastolic dysfunction (DD). We studied clinical outcomes in subtypes of acute HF in people with diabetes.

Methods: A retrospective audit was undertaken for patients admitted with a principal diagnosis of acute HF to a tertiary referral (RPA) Hospital from 010110 to 010612.  Clinical outcome was determined amongst those with diabetes (by ICD10 code) vs no diabetes. Then in those with diabetes, outcomes for patients with any systolic HF (SHF) were compared with DD alone at echocardiography. Outcome measures included length of hospital stay (LOS), need for intubation, inotropic support, or CPAP, and mortality. DD defined by formal echo report was compared with echocardiography DD definitions of E/E prime or left atrial enlargement.

Results: Within the total 1168 admissions with acute HF (mean±SD, age 76.8 ±12.5 years; 47.3 % female), 150 had documented diabetes (age 75.4±11.2 years; 52.3% female). Patients with diabetes had greater LOS compared with no diabetes (12.2±14.4 days vs 7.6±7.8 days, P<0.001); however there was no significant difference in mortality. Among the 150 with diabetes, DD was formally reported on echocardiography in 13% and was under-reported compared with using DD echocardiography criteria (36%). In those with diabetes and reported DD alone (n=20), compared to any SHF, there was a trend to lesser LOS (7.9±4.4 days vs 13.5±17.3 days, P=0.08). There was no difference amongst diabetic HF sub-groups in mortality and other outcomes, except SHF presence required more frequent inotropic support (P=0.02).

Conclusion: Acute heart failure patients with documented diabetes have an average greater length of hospital stay. DD is common and under-reported. Presence of diastolic dysfunction alone in those with acute HF and diabetes trends to an abbreviated length of stay, with admission duration similar to those without diabetes