Diabetes, quality of care, and in-hospital outcomes in patients hospitalized with heart failure
Abstract
Background Diabetes mellitus is frequently comorbid with heart failure (HF). It is unclear if comorbid diabetes is associated with quality of care and in-hospital mortality.Methods We analyzed 133,971 HF admissions from 431 hospitals between January 2005 and January 2010 comparing patients with and without diabetes.Results There were 54,352 (41%) patients hospitalized with HF with a history or newly diagnosed diabetes. After adjustment, patients with diabetes were as likely as patients without diabetes to appropriately receive the composite of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and β-blockers (odds ratio [OR] 0.99, 95% CI 0.94-1.04), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (OR 0.98, 95% CI 0.92-1.05), evidence-based β-blockers (OR 1.04, 95% CI 0.98-1.1), and hydralazine/nitrates (OR 1.09, 95% CI 0.99-1.2). However, patients with diabetes were less likely to receive smoking cessation counseling (OR 0.89, 95% CI 0.81-0.98) and blood pressure control (OR 0.81, 95% CI 0.78-0.84) and to attain the all-or-none composite measure (OR 0.96, 95% CI 0.93-0.99). Patients with diabetes were more likely to receive an aldosterone antagonist for reduced left ventricular ejection fraction (OR 1.05, 95% CI 1.00-1.11), lipid-lowering agent (OR 1.33, 95% CI 1.26-1.41), and influenza vaccination (OR 1.05, 95% CI 1.01-1.09). Diabetes was independently associated with longer hospital stay but not within-hospital mortality.Conclusions With few exceptions, the application of evidence-based care and in-hospital outcomes were similar whether or not diabetes was present in this large contemporary cohort of patients hospitalized with HF.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the OPTIMIZE-HF, ADHERE and Get With the Guidelines-HF registries in the United States, T2DM was not associated with higher in-hospital mortality.
“In the OPTIMIZE-HF, ADHERE and Get With the Guidelines-HF registries in the United States, T2DM was not associated with higher in-hospital mortality.82 -85”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [83]
Cites
A Randomized Trial of the Angiotensin-Receptor Blocker Valsartan in Chronic Heart Failure
Cohn, J. N., & Tognoni, G. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa010713 · Cited by 3,108 · see citing works
Poole-Wilson, P. A., Swedberg, K., Cleland, J. G., Di Lenarda, A., Hanrath, P., Komajda, M., Lubsen, J., Lutiger, B., Metra, M., Remme, W. J., et al. (2003) · The Lancet · doi:10.1016/s0140-6736(03)13800-7 · Cited by 1,872 · see citing works
Hunt, S. A., Abraham, W. T., Chin, M. H., Feldman, A. M., Francis, G. S., Ganiats, T. G., Jessup, M. L., Konstam, M. A., MANCINI, D. M., Michl, K., et al. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.11.013 · Cited by 1,367 · see citing works
HFSA 2010 Comprehensive Heart Failure Practice Guideline
Heart Failure Society of America (2010) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2010.04.004 · Cited by 1,285 · see citing works
Predicting Mortality Among Patients Hospitalized for Heart Failure
Lee, D. S., Austin, P. C., Rouleau, J. L., Liu, P. P., Naimark, D. M. J., & Tu, J. V. (2003) · JAMA · doi:10.1001/jama.290.19.2581 · Cited by 1,270 · see citing works
Predictors of mortality and morbidity in patients with chronic heart failure
Pocock, S., Wang, D., Pfeffer, M. A., Yusuf, S., McMurray, J. J. V., Swedberg, K. B., Östergren, J., Michelson, E. L., Pieper, K. S., & Granger, C. B. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi555 · Cited by 972 · see citing works
Congestive Heart Failure in Type 2 Diabetes
Nichols, G. A., Hillier, T. A., Erbey, J. R., & Brown, J. B. (2001) · Diabetes Care · doi:10.2337/diacare.24.9.1614 · Cited by 600 · see citing works
McCullough, P. A., Philbin, E. F., Spertus, J. A., Kaatz, S. S., Sandberg, K. R., & Weaver, W. D. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01700-4 · Cited by 544 · see citing works
Shindler, D. M., Kostis, J. B., Yusuf, S., Quinones, M. A., Pitt, B., Stewart, D., Pinkett, T., Ghali, J. K., Wilson, A. C., & The SOLVD Investigators (1996) · The American Journal of Cardiology · doi:10.1016/s0002-9149(97)89163-1 · Cited by 516 · see citing works
Fonarow, G. C., Abraham, W. T., Albert, N. M., Stough, W. G., Gheorghiade, M., Greenberg, B., O’Connor, C. M., Pieper, K. S., Sun, J. L., Yancy, C. W., et al. (2007) · JAMA · doi:10.1001/jama.297.1.61 · Cited by 468 · see citing works
Self-citationProfile for Estimating Risk of Heart Failure
Kannel, W. B., D’Agostino, R. B., Silbershatz, H., Belanger, A. J., Wilson, P. W. F., & Levy, D. A. (1999) · Archives of Internal Medicine · doi:10.1001/archinte.159.11.1197 · Cited by 422 · see citing works
Hernandez, A. F., Fonarow, G. C., Liang, L., Al‐Khatib, S. M., Curtis, L. H., LaBresh, K. A., Yancy, C. W., Albert, N. M., & Peterson, E. D. (2007) · JAMA · doi:10.1001/jama.298.13.1525 · Cited by 419 · see citing works
Self-citationCardiomyopathy, U. (2007) · Digest of the World Core Medical Journals(Cardiology) · Cited by 415 · see citing works
Fonarow, G. C., Abraham, W. T., Albert, N. M., Gattis, W. A., Gheorghiade, M., Greenberg, B., O’Connor, C., Yancy, C. W., & Young, J. B. (2004) · American Heart Journal · doi:10.1016/j.ahj.2004.03.004 · Cited by 340 · see citing works
Self-citationFonarow, G. C. (2003) · PubMed · Cited by 339 · see citing works
Self-citationGiugliano, D., Acampora, R., Marfella, R., De Rosa, N., Ziccardi, P., Ragone, R., De Angelis, L., & D'Onofrio, F. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-126-12-199706150-00004 · Cited by 302 · see citing works
Dries, D. L., Sweitzer, N. K., Drazner, M. H., Stevenson, L. W., & Gersh, B. J. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01408-5 · Cited by 286 · see citing works
Fonarow, G. C. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.14.1493 · Cited by 268 · see citing works
Self-citationGustafsson, I., Brendorp, B., Seibæk, M., Burchardt, H., Hildebrandt, P., Køber, L., & Torp-Pedersen, C. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.11.024 · Cited by 258 · see citing works
Jacob, S., Kristian, R. E. T. T., WICKLMAYR, M., Agrawal, B., Hj, A., & Dietze, G. J. (1996) · PubMed · Cited by 228 · see citing works
The effect of diabetes on outcomes of patients with advanced heart failure in the BEST trial
Domanski, M., Krause-Steinrauf, H., Deedwania, P., Follmann, D., Ghali, J. K., Gilbert, E., Haffner, S., Katz, R., Lindenfeld, J., Lowes, B. D., et al. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00856-8 · Cited by 215 · see citing works
Greenberg, B. H., Abraham, W. T., Albert, N. M., Chiswell, K., Clare, R., Stough, W. G., Gheorghiade, M., O'Connor, C. M., Sun, J. L., Yancy, C. W., et al. (2007) · American Heart Journal · doi:10.1016/j.ahj.2007.05.001 · Cited by 196 · see citing works
Self-citationDifferential effect of chronic treatment with two beta-blocking agents on insulin sensitivity
Jacob, S., Kristian, R. E. T. T., WICKLMAYR, M., Agrawal, B., Augustin, H. J., & Dietze, G. N.-J. (1996) · Journal of Hypertension · doi:10.1097/00004872-199604000-00012 · Cited by 183 · see citing works
Thomas, K. L., Hernandez, A. F., Dai, D., Heidenreich, P. A., Fonarow, G. C., Peterson, E. D., & Yancy, C. W. (2011) · American Heart Journal · doi:10.1016/j.ahj.2011.01.012 · Cited by 97 · see citing works
Self-citationDay of Admission and Clinical Outcomes for Patients Hospitalized for Heart Failure
Fonarow, G. C., Abraham, W. T., Albert, N. M., Stough, W. G., Gheorghiade, M., Greenberg, B., O’Connor, C. M., Núñez, E., Yancy, C. W., & Young, J. B. (2008) · Circulation Heart Failure · doi:10.1161/circheartfailure.107.748376 · Cited by 78 · see citing works
Self-citation
Flagged first, then by citations
1 of the 27 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Seferović, P. M., Petrie, M. C., Filippatos, G. S., Anker, S. D., Rosano, G., Bauersachs, J., Paulus, W. J., Komajda, M., Cosentino, F., de Boer, R. A., et al. (2018) · European Journal of Heart Failure · doi:10.1002/ejhf.1170 · Cited by 708 · see citing works
Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure
Dei Cas, A., Khan, S. S., Butler, J., Mentz, R. J., Bonow, R. O., Avogaro, A., Tschoepe, D., Doehner, W., Greene, S. J., Senni, M., et al. (2015) · JACC Heart Failure · doi:10.1016/j.jchf.2014.08.004 · Cited by 401 · see citing works
Self-citationEchouffo-Tcheugui, J. B., Xu, H., DeVore, A. D., Schulte, P. J., Butler, J., Yancy, C. W., Bhatt, D. L., Hernandez, A. F., Heidenreich, P. A., & Fonarow, G. C. (2016) · American Heart Journal · doi:10.1016/j.ahj.2016.07.025 · Cited by 160 · see citing works
Self-citationComposite measures of quality of health care: Evidence mapping of methodology and reporting
Kara, P., Valentin, J. B., Mainz, J., & Johnsen, S. P. (2022) · PLoS ONE · doi:10.1371/journal.pone.0268320 · Cited by 54 · see citing works
Nelson, A. J., Peterson, E. D., & Pagidipati, N. J. (2019) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2019.07.001 · Cited by 52 · see citing works
Johansson, I., Edner, M., Dahlström, U., Näsman, P., Rydén, L., & Norhammar, A. (2013) · European Journal of Heart Failure · doi:10.1002/ejhf.44 · Cited by 52 · see citing works
Bonora, B. M., de Kreutzenberg, S. V., Avogaro, A., & Fadini, G. P. (2019) · Cardiovascular Diabetology · doi:10.1186/s12933-019-0910-5 · Cited by 35 · see citing works
Glucose-Lowering Therapies and Heart Failure in Type 2 Diabetes Mellitus
Vijayakumar, S., Vaduganathan, M., & Butler, J. (2018) · Circulation · doi:10.1161/circulationaha.117.032099 · Cited by 32 · see citing works
Ferrini, M., Johansson, I., & Aboyans, V. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487319885461 · Cited by 21 · see citing works
Elevated serum glucose levels and survival after acute heart failure: A population-based perspective
Helfand, B., Maselli, N. J., Lessard, D., Yarzebski, J., Gore, J. M., McManus, D. D., Saczynski, J. S., & Goldberg, R. J. (2014) · Diabetes and Vascular Disease Research · doi:10.1177/1479164114559024 · Cited by 18 · see citing works
Age affects the prognostic impact of diabetes in chronic heart failure
Cunha, F. M., Pereira, J. C., Ribeiro, A., Amorim, M., Silva, S., Araújo, J. P., Leite-Moreira, A. F., Bettencourt, P., & Lourenço, P. (2018) · Acta Diabetologica · doi:10.1007/s00592-017-1092-9 · Cited by 15 · see citing works
Glycemic Variability and Glycemic Control in the Acutely Ill Cardiac Patient
Moore, J., & Dungan, K. M. (2012) · Heart Failure Clinics · doi:10.1016/j.hfc.2012.06.006 · Cited by 12 · see citing works
Johansson, I., & Norhammar, A. (2021) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2021.108822 · Cited by 11 · see citing works
Masip, J., Povar-Echeverría, M., Peacock, W. F., Jacob, J., Gil, V., Herrero, P., Llorens, P., Alquézar‐Arbé, A., Sánchez, C., Martín‐Sánchez, F. J., et al. (2022) · Internal and Emergency Medicine · doi:10.1007/s11739-022-02965-3 · Cited by 11 · see citing works
Glycated Hemoglobin and Outcomes of Heart Failure (from Get With the Guidelines-Heart Failure)
Echouffo-Tcheugui, J. B., Sheng, S., DeVore, A. D., Matsouaka, R., Hernandez, A. F., Yancy, C. W., Heidenreich, P. A., Bhatt, D. L., & Fonarow, G. C. (2018) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2018.11.023 · Cited by 8 · see citing works
Self-citationHuo, X., Zhang, L., Bai, X., He, G., Li, J., Miao, F., Lu, J., Liu, J., Zheng, X., & Li, J. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.883737 · Cited by 7 · see citing works
Cox, Z. L., Lai, P., Lewis, C. M., & Lindenfeld, J. M. (2019) · International Journal of Cardiology · doi:10.1016/j.ijcard.2019.07.069 · Cited by 6 · see citing works
Gallucci, F., Ronga, I., Fontanella, A., Uomo, G., & And the FASHION Study Group (2017) · Italian Journal of Medicine · doi:10.4081/itjm.2017.705 · Cited by 4 · see citing works
Asthma as a Comorbidity in Hospitalized Patients
Self, T. H., Owens, R. E., Mancell, J., & Nahata, M. C. (2016) · Annals of Pharmacotherapy · doi:10.1177/1060028016641132 · Cited by 2 · see citing works
Shultz, C. G. (2012) · Deep Blue (University of Michigan)
Begum, N., Abdullah, A. S., Khan, M. A. H., Sultana, A. W., Osmany, D., & Mollah, F. H. (2014) · Chattagram Maa-O-Shishu Hospital Medical College Journal · doi:10.3329/cmoshmcj.v13i1.19409
Vijayakumar, S., Vaduganathan, M., & Butler, J. (2018) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2018.1423962
Sharma, D. S. (2018) · Journal of Medical Science And clinical Research · doi:10.18535/jmscr/v6i8.46
Paneni, F., & Cosentino, F. (2015) · Springer eBooks · doi:10.1007/978-3-319-17762-5_14
Adherence to the therapy of patients with Heart Failure and Diabetes Mellitus: A Systematic Review
Philippou, K., Kyriakou, M., Middleton, N., Charalambous, A., Raftopoulos, V., Constantinou, M., & Lambrinou, E. (2023) · Medical Research Archives · doi:10.18103/mra.v11i12.4585
Chapra, A. F., Kaddoura, R., Patel, A. A. A. H., Francis, T., Varghese, S., Ibrahim, M. I. M., Shah, J. Z., Alsadi, H., Elasfar, A., Badr, A., et al. (2026) · Frontiers in Clinical Diabetes and Healthcare · doi:10.3389/fcdhc.2026.1719223
- Authors
- Kapoor, J. R., Fonarow, G. C., Zhao, X., Kapoor, R., Hernandez, A. F., & Heidenreich, P. A.
- Affiliations
- University of Chicago (US)
- University of California, Los Angeles (US)
- Duke Clinical Research Institute (US)
- Harvard University (US)
- VA Palo Alto Health Care System (US)
- Corresponding author
- Kapoor, John R.
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2011-09
- Volume
- 162
- Issue
- 3
- Pages
- 480-486.e3
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W2100397067
- Cited by
- 26
- References
- 27
- Citations by year
- 2026: 1 · 2023: 1 · 2022: 3 · 2021: 1 · 2019: 4 · 2018: 6 · 2017: 1 · 2016: 2 · 2015: 2 · 2014: 2 · 2013: 1 · 2012: 2
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Novartis
- Medtronic
- National Heart, Lung, and Blood Institute
- GlaxoSmithKline
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes mellitus, heart failure, quality of care, in-hospital mortality, guideline-directed therapy, ACE inhibitors, angiotensin receptor blockers, beta-blockers, smoking cessation counseling, blood pressure control, mineralocorticoid receptor antagonists, lipid-lowering drugs, influenza vaccination, length of hospital stay, comorbidities
- MeSH terms
- Aged, Diabetes Mellitus, Female, Heart Failure, Humans, Inpatients, Male, Prospective Studies, Quality of Health Care, United States, Comorbidity, Incidence, Hospital Mortality
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
