Connection between Heart Failure, Diabetes, and Overall Mortality in Individuals with Suicidal Ideation: Findings from a Nationally Representative Study

Abstract

Heart Failure hospitalizations and readmissions continue to rise due to many factors, including increased prevalence of the disease, lack of guideline directed therapy, and lack of patient adherence. The precise contributory relationship of diabetes and congestive heart failure (CHF) is poorly understood.Adult respondents of the National Health and Nutrition Examination Survey NHANES survey aged 20 or older with a self-reported positive history of suicidal ideation between the years 2005-2010 were included in the analysis, with follow-up through 2015. Analysis was performed using complex samples Cox regression to determine the relationship of CHF on all-cause mortality and the influence, if any, of diabetes status.Percent mortality among individuals with CHF was 12.6% among males and 11.2% among females, with mean follow-up of 7.4 years. For all-cause mortality, the overall unadjusted hazard ratio (HR) for CHF to no CHF was 8.90 (95% confidence interval [CI], 3.84-20.65, p < 0.001). The adjusted HR was elevated, 23.91 (CI 2.94-194.32, p = 0.004), among individuals who had CHF and diabetes but closer to 1.0 (3.57 CI 0.56-19.95, p = 0.18) among individuals who had CHF and no diabetes, after adjusting for medical and demographic risk factors. No significant similar patterns were found among the general population.Analysis of the data suggests that adults with suicidal ideation and a combination of positive diabetes and CHF status experience 24 times higher mortality rates than those adults with CHF alone. Conclusions include the need to develop and administer diabetes education programs and health promotion that address CHF risk factors to improve diabetes prognosis while also recognizing early warning mental health signs.