Comorbid Congestive Heart Failure Research Articles

Illness intrusiveness, health locus of control, and anxiety symptoms among veterans with congestive heart failure.

Disease severity, illness intrusiveness, and health locus of control (HLC) each contribute to psychosocial wellbeing in patients with congestive heart failure (CHF). To better understand the relationships between these variables regarding anxiety symptoms, we analyzed data from 116 adult male veterans with comorbid CHF and anxiety. Results suggested that illness intrusiveness significantly mediated the relation of CHF severity to anxiety symptom severity, and that the illness intrusiveness domains of physical well-being/diet, work/finances, and other aspects of life (religious/spirituality, community/civic, self-improvement/expression) were also significant mediators of that relationship. The relation of illness intrusiveness to anxiety was not moderated by internal HLC. Findings highlight the importance of assessing and treating various aspects of illness intrusiveness to manage anxiety symptoms in CHF patients.

Association of congestive heart failure with hospital outcomes among patients with chronic lymphocytic leukemia in the United States: Analysis of nationwide inpatient sample.

e19506 Background: Chronic Lymphocytic Leukemia (CLL) is adults' most prevalent chronic leukemia. There is an increased report of cardiovascular comorbidities in these patients due to the multi-systemic impact of both the insidious disease and the associated side effects of its treatment. This study aimed to provide real-world contemporary data on the in-hospital outcomes among patients admitted for CLL with comorbid Congestive Heart Failure (CHF) in the United States. Methods: The study is a retrospective study that used the National Inpatient Sample database. We identified patients hospitalized for CLL from 2018-2020 and stratified them into two cohorts – with CHF and without CHF. Inclusion criteria include age ≥ 18 years and hospitalization primarily for active CLL. We excluded patients with aortic stenosis and those whose CLL were in remission. Inferential statistics - chi-squared test and Student t-test (as applicable) - was done on extracted data. The odds ratio was calculated using univariate and multivariate analyses. All analyses were done at a 95% confidence interval with a 2-tailed p-value <0.05 set as the cut-off for statistical significance. Results: A total of 210,012 hospitalizations of CLL were identified, of which 27.5% (57,650) had comorbid CHF. On univariate logistics regression analysis, the average length of hospitalization was statistically (p<0.001) prolonged by one day, and the cost of hospitalization increased by 9,640 + 1482 US dollars among those with CHF and active CLL. The odds of all-cause in-hospital mortality increased by 1.6 folds in these patients (P<0.001). However, after adjusting for individual patients and hospital-level cofounders, active CLL did not have a significant clinical impact on the duration and total cost of heart failure hospitalization. Active CLL, however, significantly increased the risk of all-cause in-hospital mortality by 1.3 folds (4.7% vs 7.2%; adjusted odds ratio 1.31, 95% CI 1.17-1.46; p<0.01) in patients with heart failure. Conclusions: Patients hospitalized for active CLL with a comorbid diagnosis of CHF have increased odds of in-hospital mortality compared to those without comorbid heart failure. This finding suggests the need for integrative multi-disciplinary care for CLL patients with comorbid CHF, such as cardio-oncology.

Risk Factor Analysis of Venous Thromboembolism in Cancer: A National Inpatient Sample Study

ObjectiveIn this study, we aimed to explore the association of demographic characteristics and comorbidities with the risk of venous thromboembolism (VTE) in cancer inpatients, as well as to delineate the mortality risk in cancer inpatients with VTE.MethodsWe conducted a retrospective cohort analysis based on the National Inpatient Sample (NIS) 2012-2014, involving 339,395 inpatients with a primary diagnosis of cancer subdivided into cohorts without VTE (n=331,695) and with VTE (n=7,700). We used a binomial logistic regression model to evaluate the odds ratio (OR) of demographics, comorbidities, and in-hospital mortality rate with respect to cancer inpatients with VTE.ResultsA higher proportion of cancer inpatients with VTE were 36-50 years in age (83.1%), male (50%), and of black (19.3%) and Hispanic ethnicity (17.2%) compared to the non-VTE cohort. The prevalence of comorbidities was higher in the VTE cohort, including HIV/AIDS, congestive heart failure (CHF), chronic pulmonary disease, diabetes, hypertension, and obesity. CHF demonstrated the highest risk of association with VTE (OR: 2.68, 95% CI: 2.30-3.12), followed by hypertension (OR: 1.23, 95% CI: 1.16-1.29), diabetes (OR: 1.16, 95% CI: 1.07-1.26), and chronic pulmonary disease (OR: 1.13, 95% CI: 1.05-1.22). Conversely, valvular diseases, obesity, and drug abuse were not significantly associated with VTE in cancer inpatients. The in-hospital mortality rate was higher in cancer inpatients with VTE (12% vs. 2.1%), thereby increasing the in-hospital mortality risk (OR: 3.87, 95% CI: 3.58-4.18).ConclusionVTE risk was significantly higher in cancer patients with comorbid CHF, hypertension, diabetes, and chronic pulmonary disease. The risk of all-cause in-hospital mortality was increased by four times in cancer inpatients with VTE.

Outcomes of CMS-mandated fluid administration among fluid-overloaded patients with sepsis: A systematic review and meta-analysis

IntroductionThe outcomes of large-volume IVF administration to septic shock patients with comorbid congestive heart failure (CHF) and/or end-stage renal disease (ESRD) are uncertain and widely debated in the existing literature. Despite this uncertainty, CMS continues to recommend that 30 ml/kg of an intravenous crystalloid solution be administered to patients in septic shock starting within 3 h of presentation. We performed a systematic review and meta-analysis to assess the relationship between adherence to this guideline and outcomes among patients whose underlying comorbidities present a risk of fluid overload. MethodsOur search was conducted on PubMed and Scopus through November 5, 2021 to identify studies that evaluated clinical outcomes among septic patients with CHF/ESRD based on volume of fluid administered. The primary outcome measured was mortality at 30 days post-hospital discharge. Other outcomes included the rates of vasopressor requirements, invasive mechanical ventilation during hospitalization, as well as length of stay in the intensive care unit and/or hospital. We used random effects meta-analysis when two or more studies reported the same outcome. ResultsWe included five studies in the final meta-analysis, which comprised 5804 patients, 5260 (91%) of whom received non-aggressive fluid resuscitation, as defined by the studies' authors. Random-effects meta-analysis for all-cause mortality showed that aggressive fluid resuscitation was associated with statistically non-significant increased odds of mortality (OR 1.42, 95% CI 0.88–2.3, P = 0.15, I2 = 35%). There was no statistical association between volume of IVF administration and other outcomes evaluated. ConclusionAmong septic shock patients with CHF and/or ESRD, administration of greater than or equal to 30 ml/kg IVF was associated with a non-significant increase in odds of mortality. All other outcomes measured were found to be non-significant, although there was a trend toward better outcomes among patients in the restricted-volume compared to the standard-volume IVF groups. Since this meta-analysis only included five observational studies, more studies are needed to guide an optimal volume and rate of fluid administration in this patient population.

Association of congestive heart failure with hospital outcomes among renal cancer patients in the United States: analysis of nationwide inpatient sample

ABSTRACT Background: Patients with renal cancer are at increased risk of comorbid congestive heart failure (CHF) due to several shared risk factors and the cardiotoxicity of some medications used for renal cancer treatment. We aimed to examine the relationship between CHF and hospital outcomes among renal cancer patients in the U.S. Methods: In this cross-sectional study, we identified hospitalizations of renal cancer patients using the 2015–2017 National Inpatient Sample. We assessed the relationship between CHF and hospital outcomes in this patient population, including in-hospital mortality, length-of-stay (LoS), and hospital costs. Results: Among the 20,321 hospitalizations of renal cancer patients identified, 6.1% involved patients with comorbid CHF (n = 1,231). The odds of in-hospital mortality did not differ based on CHF presence (odds ratio = 1.21; p = 0.354). Hospitalizations of renal cancer patients with CHF were associated with a greater LoS (incidence rate ratio = 1.44; p < 0.001) and higher hospital costs (cost ratio = 1.27; p < 0.001) than those without CHF. Conclusions: CHF in renal cancer patients is associated with increased LoS and higher hospital costs. These findings suggest that optimal management of comorbid CHF may improve hospital outcomes in patients with renal cancer and provides evidence to support the emerging field of cardio-oncology.

Impacts of Comorbid Chronic Obstructive Pulmonary Disease and Congestive Heart Failure on Prognosis of Critically Ill Patients.

BackgroundComorbid congestive heart failure (CHF) was associated with worse prognosis in patients with chronic obstructive pulmonary disease (COPD), while few studies specially investigated critically ill patients. This study investigated the associations between comorbid COPD with or without CHF and prognosis of patients admitted to intensive care units (ICU).MethodsWe conducted a retrospective cohort study in the Medical Information Mart for Intensive Care III database. Adult ICU patients were included and categorized as patients without COPD and CHF, patients with COPD but without CHF, patients with CHF but without COPD, and patients with both COPD and CHF. The study outcomes were 28-day mortality and 90-day mortality after ICU admission. Kaplan–Meier curves were plotted to estimate the survival distributions between groups and multivariable Cox regression analyses were employed to evaluate the associations between comorbid COPD and/or CHF and the study outcomes.ResultsA total of 29,589 patients were included with 20,507 patients without COPD and CHF, 1575 patients with COPD, 6190 patients with CHF, and 1317 patients with both COPD and CHF. The highest 28-day mortality rate and 90-day mortality rate were found in patients with both COPD and CHF (15.95% and 25.74%, respectively), while patients with COPD and patients with CHF had similar mortality rates, also observed in Kaplan–Meier curves. Compared with patients without COPD or CHF, comorbid COPD or CHF both significantly increased the risk of 28-day mortality and 90-day mortality, but comorbid COPD and CHF together was associated with the highest risk of mortality (hazard ratio 1.55 (95% confidence interval (CI) 1.33–1.80) and 1.25 (95% CI 1.16–1.35) for 28-day mortality and 90-day mortality, respectively), while no significant interaction between COPD and CHF was found.ConclusionICU patients with comorbid COPD or CHF both experienced greater mortalities, while these two risk factors seemed to play an independent role.

Emergency Department Utilization After Outpatient Hand Surgery.

The purpose of this study was to identify the utilization rate and most common reasons for presentation to the emergency department (ED) after elective outpatient hand surgery and to determine preoperative risk factors for these ED visits. Patients who underwent elective hand surgery at an ambulatory surgery center between 2014 and 2015 were retrospectively evaluated using the New York and Florida State Databases. The primary outcome was all-cause 7- and 30-day ED utilization rates. Reasons for presentation to the ED were recorded and manually stratified. Bivariate and multivariate analyses were performed to identify independent predictors of ED utilization. From 2014 to 2015, 212,506 procedures were identified; the 7- and 30-day ED visit rates were 1.8% and 4.4%, respectively. Postoperative pain was the most common cause of an ED visit after outpatient hand surgery at 7 days (25.4%) and 30 days (16.1%) postoperatively. Overall, 98% of patients presenting to the ED for postoperative pain were subsequently discharged home. After controlling for confounding, comorbid congestive heart failure, chronic lung disease, diabetes, renal failure, schizophrenia, and depression were independent risk factors for an ED visit at up to 30 days postoperatively. Those with Medicare insurance were 94% more likely to present to the ED within 30 days than those with private health insurance, whereas those with Medicaid were more than three times as likely to present to the ED as those with private insurance. ED utilization after outpatient hand surgery is low, with postoperative pain being the most common cause of an ED visit at all time points. Nearly 98% of patients presenting to the ED for postoperative pain are subsequently discharged home. Level III, Retrospective Cohort.

Clinical Predictors of Intubation and In-Hospital Death in Lung Cancer Patients Admitted for Acute Radiation Pneumonitis: A Healthcare Cost and Utilization Project (HCUP) Analysis

Acute radiation pneumonitis is a dose-limiting toxicity of thoracic radiotherapy which can result in mortality. The purpose of this study was to identify predictors of intubation and in-hospital death among patients with lung cancer admitted for acute radiation pneumonitis. The Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database was queried from 2012 through 2015 to capture hospitalized adult patients with a principal diagnosis of acute radiation pneumonitis. Patients were included in this study if they also had a diagnosis of lung cancer. Variables examined included age, gender, race, smoking status, diagnosis of interstitial lung disease (ILD), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), connective tissue disease/rheumatoid arthritis, median household income by household zip code, and season/weekday of admission. Chi-squared and multivariable logistic regression modeling were used to determine predictors of in-hospital death, intubation, and length of stay (LOS). Of 674 patients who met inclusion criteria, 6 (0.9%) had a diagnosis of ILD, 113 (16.7%) had a diagnosis of CHF, and 296 (43.9%) were female. The mean age was 70.3 years (range, 35-90), and the average LOS was 6.4 days (range, 0-64). During admission, 53 (7.9%) patients expired, and 72 (10.7%) patients required intubation. Predictors of death on univariable analysis were ILD and higher income quartile by household zip code. On multivariable logistic regression, only ILD (HR 12.5, 95% CI 2.5-63.6, p = 0.002) remained a significant predictor of death. Significant predictors of intubation on univariable analysis were CHF and higher income quartile by household zip code. CHF (HR 2.3, 95% CI 1.3-4.0, p = 0.005) and higher income quartile by household zip code (p = 0.027) remained significant on multivariable logistic regression. Predictors of extended LOS on multivariable analysis were CHF (HR 2.1, 95% CI 1.4 – 3.1, p = 0.001) and COPD (HR 1.6, 95% CI 1.1 – 2.2, p = 0.009). In a large cohort of lung cancer patients hospitalized with a principal diagnosis of acute radiation pneumonitis, ILD was a significant predictor of in-hospital death, while co-morbid CHF was an important predictor of intubation. These findings confirm the importance of comorbid diagnoses in predicting outcomes during hospitalization for lung cancer patients treated with radiotherapy.

Congestive heart failure presence predicts delayed healing of foot ulcers in diabetes: An audit from a multidisciplinary high-risk foot clinic

AimsThis retrospective study aimed to investigate both established and less well-explored factors as potential predictive variables for failed and delayed ulcer healing. MethodsPatients with type 1 or 2 diabetes with foot ulceration presenting consecutively to, and then subsequently managed at, a multidisciplinary, high-risk foot clinic were followed until ulcer healing, amputation or death. Data comprised prospective standardised documentation at each visit and retrospective collection from hospital records, and included patient demographics, comorbidities, laboratory variables, and ulcer infection, depth and area at each presentation. Multiple regression analysis was used to determine independent predictors of failure to heal and delayed healing. ResultsOf the 107 consecutive patients studied, 95 (89%) healed overall, 50 (47%) had healed in 12 weeks and the mean healing rate was a 10% decrease in ulcer area per week. Amongst all variables examined, comorbid congestive heart failure (CHF) was the only factor independently predictive of all measured outcomes of failure to heal overall, delayed healing at 12 weeks, and reduced healing rate. Ulcer infection at presentation, longer duration of antibiotic use, and liver enzyme abnormalities of raised ALT and AST:ALT<1 (each suggestive of non-alcoholic fatty liver disease), were also predictive of poor ulcer outcomes. ConclusionsComorbid congestive cardiac failure is predictive of delayed foot ulcer healing rate as well as a lower probability of healing overall. Liver enzyme abnormalities also predicted delayed ulcer healing outcomes. The mechanisms underlying these associations with foot ulcer outcomes in diabetes are unclear. Further studies are needed to determine the role of systematic routine documentation of heart failure and its severity, and then targeting of heart failure to potentially aid the management of foot ulcers in diabetes.

Hemoglobin A1c, comorbid conditions and all-cause mortality in older patients with diabetes: A retrospective 9-year cohort study

AimsTo examine whether hemoglobin A1c levels and comorbid conditions are related to all-cause mortality in a cohort of patients with type 1 or 2 diabetes receiving continuous care for 9 years. In patients with comorbid congestive heart failure (CHF), we test for ‘reverse epidemiology,’ or whether greater HbA1c values are associated with lower risk of mortality. MethodsThe population for this longitudinal cohort study was 8820 Group Health enrollees in the Seattle area with type 1 or 2 diabetes in 1997 and enrolled continuously from 1997 to 2006. Comorbid conditions were hypertension, coronary artery disease, congestive heart failure, depression, and chronic pulmonary disease. Mistimed HbA1c scores were addressed by multiple imputation, and Cox proportional hazards models estimated associations controlling for other risk factors. ResultsAbout 30% of the enrollees died in 1998–2006. CHF had the strongest association with all-cause mortality. Compared to enrollees with HbA1c≥7.1% (54mmol/mol) and <7.5% (58mmol/mol; 5th decile), enrollees with HbA1c<6.4% (46mmol/mol) had a significantly greater risk of death (HR range: 1.28–2.26). HbA1c>7.5% had HR<1.0 but were not significant. For enrollees with diabetes and CHF at baseline, HbA1c scores≥8.7% (72mmol/mol) had a significantly lower risk of death (HR range: 0.64–0.69). ConclusionsIn our patient population, HbA1c scores<6.4% have significantly higher all-cause mortality. CHF is a major determinant of all-cause mortality. Adults with comorbid CHF and high HbA1c scores have lower all-cause mortality.

National trends in utilization, mortality, and survival after repair of type B aortic dissection in the Medicare population

The application of thoracic endovascular aortic repair (TEVAR) has changed treatment paradigms for thoracic aortic disease. We sought to better define specific treatment patterns and outcomes for type B aortic dissection treated with TEVAR or open surgical repair (OSR). Medicare patients undergoing type B thoracic aortic dissection repair (2000-2010) were identified by use of a validated International Classification of Diseases, Ninth Revision diagnostic and procedural code-based algorithm. Trends in utilization were analyzed by procedure type (OSR vs TEVAR), and patterns in patient characteristics and outcomes were examined. Total thoracic aortic dissection repairs increased by 21% between 2000 and 2010 (2.5 to 3 per 100,000 Medicare patients; P= .001). A concomitant increase in TEVAR was seen during the same interval (0.03 to 0.8 per 100,000; P< .001). By 2010, TEVAR represented 27% of all repairs. TEVAR patients had higher rates of comorbid congestive heart failure (12% vs 9%; P< .001), chronic obstructive pulmonary disease (17% vs 10%; P< .001), diabetes (8% vs 5%; P< .001), and chronic renal failure (8% vs 3%; P< .001) compared with OSR patients. For all repairs, patient comorbidity burden increased over time (mean Charlson comorbidity score of 0.79 in 2000, 1.10 in 2010; P= .04). During this same interval, in-hospital mortality rates declined from 47% to 23% (P< .001), a trend seen in both TEVAR and OSR patients. Whereas in-hospital mortality rates and 3-year survival were similar between patients selected for TEVAR and OSR, there was a trend toward women having slightly lower 3-year survival after TEVAR (60% women vs 63% men; P= .07). Surgical treatment of type B aortic dissection has increased over time, reflecting an increase in the utilization of TEVAR. Overall, type B dissection repairs are currently performed at lower mortality risk in patients with more comorbidities.

Medical comorbidity associated with psoriasis in adults: a population-based study

Most publications to date on comorbidities associated with psoriasis have focused on cardiovascular and metabolic diseases. Few comprehensive investigations of medical comorbidities in a cohort of patients with psoriasis appear in the literature. To examine the prevalence of comorbidities in adult patients with psoriasis, including a comparison of comorbid prevalence vs. that in controls without psoriasis, in a nationally representative dataset in Taiwan. There were 1685 adult patients with psoriasis in the study group and 5055 randomly selected subjects in the comparison group. We used conditional logistic regression analyses to examine the risk of 29 comorbidities for these two groups after adjusting for monthly income, geographical region of residence and the level of urbanization of each patient's community of residence. After adjusting for several potential confounders, patients with psoriasis had higher odds of comorbid congestive heart failure [odds ratio (OR) 1·63], ischaemic heart disease (OR 1·51), renal failure (OR 1·45), uncomplicated diabetes (OR 1·37), liver diseases (OR 1·34), hepatitis B or C (OR 1·34), complicated diabetes (OR 1·32), hyperlipidaemia (OR 1·28), hypertension (OR 1·24) and peptic ulcer (OR 1·22) than did patients without psoriasis. However, patients with mild psoriasis had higher odds of comorbidity only with uncomplicated diabetes (OR 1·55), asthma (OR 1·30), liver diseases (OR 1·30) and peptic ulcer (OR 1·26) than patients without psoriasis. We conclude that psoriasis is associated with a variety of medical comorbidities including cardiovascular diseases, metabolic diseases, renal failure, liver diseases, viral hepatitis B or C, asthma and peptic ulcers.

Pharmacotherapy for atrial fibrillation in elderly hospitalized patients with comorbid congestive heart failure in australia: A retrospective study

Background: Despite the proven effectiveness of antiplatelet and anticoagulation treatment for atrial fibrillation (AF), their use has been suboptimal in practice, particularly in rural areas of Australia. Objective: The aim of this study was to describe medication use in the management of AF in elderly hospitalized patients with comorbid congestive heart failure (CHF). Methods: The hospital records of patients with a diagnosis of AF and CHF were reviewed in a rural Australian medical center. All the patients were hospitalized because of significant systolic ventricular dysfunction. The collected data included age, sex, weight, presenting symptoms of AF, and principle diagnosis on admission; medical history; and history of smoking and alcohol consumption. Electrocardiogram before hospital discharge was also retrieved from patient's medical records and was analyzed by the investigators. Cardiovascular and noncardiovascular drugs administered during the hospital stay and at discharge were also documented. Comparison of antiarrhythmic and anticoagulant drugs was made between patients who had AF while hospitalized and those who had a history of AF but were in sinus rhythm while hospitalized. When patients had ≥2 moderate risk factors (eg, age ≥75 years, hypertension, CHF, left ventricular ejection fraction ≤35%, diabetes mellitus) or ≥1 high risk factor (eg, previous stroke, transient ischemic attack or embolism, mitral valve stenosis, or prosthetic heart valve), they were defined as being eligible for anticoagulation treatment. Results: One hundred forty patients (74 men, 66 women; mean [SD] age, 77.1 [6.9] years; all were white) had a diagnosis of AF and were selected for the study. Of these, 92 patients (65.7%) (47 women, 45 men; mean [SD] age, 77.4 [9–2] years) had continuous AF and 48 patients (34.3%) (29 men, 19 women; mean [SD] age, 76.3 [12.4] years) had a history of AF but were in sinus rhythm at admission and discharge. The most commonly used antiarrhythmic drug was digoxin, which was prescribed significantly more frequently in the AF group than in the history of AF group (50 (54.3%] vs 14 [29.2%]; P < 0.01). Amiodarone was prescribed significantly less frequently in the continuous AF group than in the group with a history of AF (7 [7.6%] vs 19 [39−6%]; P < 0.01). There was no significant between-group difference in the use of β-blockers (26 [28.3%] vs 19 [39−6%]), verapamil/diltiazem (9 [9–8%] vs 3 [6.3%]), or Sotalol (2 [2.2%] vs 4 [8.3%]). The mean (SD) resting heart rate for the 140 study patients was 91 (27) bpm. The mean resting heart rate for the patients with AF was significantly higher at admission than at discharge (97 [28] vs 79 [19] bpm; P < 0.01). Of the 110 patients who were eligible for anticoagulation treatment, 64 (58.2%) were prescribed warfarin at discharge. Eligible patients not receiving oral warfarin were significantly older than those who did receive warfarin (79−7 [9−0] vs 75.8 [9.0] years; P = 0.02). Conclusions: In these elderly hospitalized Australian patients with AF and CHF, digoxin, β-blockers, and amiodarone were the most commonly used antiarrhythmic drugs. Anticoagulation treatment was prescribed in ~60% of these patients.

Preventable hospitalization among elderly Medicare beneficiaries with type 2 diabetes.

To examine the impact of comorbid conditions on preventable hospitalizations among Medicare beneficiaries aged > or =65 years with type 2 diabetes. Data were drawn from the 1999 Medicare Standard Analytic Files, a 5% nationally representative random sample of Medicare beneficiaries. The analysis sample included 193,556 Medicare beneficiaries aged > or =65 years with type 2 diabetes (ICD-9-CM codes 250.xx) who were enrolled in fee-for-service Medicare. Preventable hospitalization was assessed by measuring ambulatory care-sensitive conditions, an accepted measure of hospitalizations that could have been prevented with appropriate outpatient care. Multivariable analyses controlled for demographics; mortality; renal, ophthalmic, or neurological manifestations of diabetes; type of physician providing the outpatient care; and per capita community-level indicators of income and hospital beds. Ninety-six percent of beneficiaries in the sample had a comorbidity, and 46% had five or more comorbidities. Among beneficiaries with type 2 diabetes, cardiovascular-related comorbidities were common and accounted for increased odds of preventable hospitalization, controlling for other factors. The likelihood of a preventable hospitalization increased in the presence of a claim for comorbid congestive heart failure, cardiomyopathy, coronary atherosclerosis, hypertension, or cardiac dysrythmias. Noncardiovascular comorbidities associated with a greater likelihood of preventable hospitalization included chronic obstructive pulmonary disease, asthma and lower respiratory disorders, Alzheimer's disease/dementia, personality/anxiety disorders, depression, and osteoporosis. Our data suggest that nearly 7% of all hospitalizations could be avoided. These findings support the need for improved outpatient care strategies to reduce the impact of comorbidity on unnecessary hospitalization in patients aged > or =65 years with type 2 diabetes.