1560-P: A History of CHF Predicts Adverse Outcomes of Hospitalizations for Hyperglycemic Crises—Data from National and Local Cohorts

Background: The impact of a history of congestive heart failure (CHF) on the outcomes of DKA and HHS hospitalizations is unknown, and current guidelines provide no clear recommendations for patients with CHF history. Objective: To test the hypothesis that a history of CHF impacts the outcomes of DKA/HHS hospitalizations. Design: Retrospective cohort study of DKA/HHS hospitalizations using Nationwide Inpatient Sample (NIS) database 2003 to 2014 (n= 1,793,983) and University Hospital cohort (n= 1,528). Outcomes: All cause in-hospital mortality, acute respiratory failure events, length of stay and post discharge utilization of nursing home. Results: In the NIS cohort, a history of CHF was present in 83,173 (4.6%) patients among DKA/HHS hospitalizations and was associated with higher adverse outcomes (mortality: 2.8% in CHF vs. 0.6% in no-CHF, adjusted odds ratio (AOR) = 1.5, 95% confidence interval (CI) 1.4 to 1.6; acute respiratory failure- 9.8% vs. 2.2%, AOR = 2.1, 95% CI 2.0 to 2.2). CHF history also predicted higher utilization of post discharge nursing home services (19.6% vs. 5.2%, AOR = 1.4, 95% CI 1.3 to 1.5) even after extensive adjustment for patient demographics, Elixhauser comorbidities and Charlson comorbidity index. In the University cohort, CHF history was present in 129 (8.4%) patients among 1,528 HGc hospitalizations and was associated with higher in-hospital complications (in-hospital mortality and acute respiratory failure [(13.2% vs. 5.2%, AOR = 2.1, 95% CI 1.2 to 3.7)] and higher utilization of post discharge nursing home (15.2% vs. 2.6%, AOR = 2.5, 95% CI 1.3 to 4.7) when compared with those without CHF. Mean length of stay was higher in patients with CHF history compared with no-CHF history in both datasets. Conclusions: A history of CHF is an under-recognized risk factor for adverse outcomes of hospitalizations for hyperglycemic crises. Prospective studies are warranted to better understand and mitigate these differences in outcomes.