Abstract 9804: Diabetes Mellitus and Acute Heart Failure With Reduced Ejection Fraction: A National Database Study

Abstract

Background: Literature regarding outcomes of acute heart failure with reduced ejection fraction (HFrEF) in patients with diabetes mellitus (DM) is still evolving. Objective: To study the all-cause mortality and clinical outcomes of acute HFrEF in diabetic patients. Methods: Data from the National Emergency Department Sample (NEDS), which constitutes 20% of the sample of hospital-owned emergency departments (ED) in the United States (US), was analyzed for hospital encounters related to acute HF and DM using International Classification of Diseases-10 (ICD-10) codes. Results: Out of the total 1,479,716 acute HF encounters (mean age 69.7±14.9 years,47.3%females) recorded for the years 2016-2018, 803,308 (54.3%) were acute HFrEF-related, with 317,517 (39.5%) HFrEF with DM. The HFrEF with DM group had higher multi-organ complications including NSTEMI (14.6% vs 12.9%; p-value <0.001), acute kidney injury (AKI) (29.3% vs 26.2%; p-value <0.001), AKI requiring hemodialysis (10.5% vs 6.7%; p-value <0.001) when compared to HFrEF group only. However, the all-cause mortality for HFrEF only was higher as compared to HFrEF with DM (5% vs 4.8%; p <0.001). Moreover, HFrEF with DM group had higher coronary interventions including PCI (7.6% vs 7.1%; p-value <0.001), and CABG (1.9% vs 1.4%; p-value <0.001). Conclusion: Surprisingly, HFrEF complicated by DM did not show significant worsening in mortality rates compared to patients with acute HFrEF. Ischemic cardiac work-up showed mortality benefits. The possibility of selection bias for ischemic cardiac procedures suggest more randomized trials to evaluate the hypothesis generated. Keywords: Acute heart failure with reduced ejection fraction (HFpEF), diabetes mellitus (DM), all-cause mortality, Percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG).