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Hyperglycemia is associated with increased length of stay and total cost in patients hospitalized for congestive heart failure

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DOI: 10.4236/wjcd.2013.32038    2,920 Downloads   5,024 Views   Citations

ABSTRACT

Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness; however, its effect in congestive heart failure (CHF) is controversial. We hypothesized that persistent hyperglycemia is associated with increased length of stay (LOS) and increased total cost in patients admitted with CHF. Methods: We studied 203 consecutive patients admitted with a primary diagnosis of CHF. Patient characteristics, admission glucose, mean blood glucose (MBG) during the entire hospital stay, length of stay, total cost, and readmission rates were assessed. Persistent hyperglycemia was defined as a MBG level ≥140 mg/dl. Results:Patients with persistent hyperglycemia had longer mean LOS (8.1 vs 5.2 days, p = 0.001) and higher total hospital costs (median $8940 vs $6892, p = 0.01) independent of diabetes status. Similarly, prolonged hospital stay >7 days (38% vs 21%; p = 0.01) and total cost >$10,000/patient (46% vs 29%; p = 0.01) were seen more commonly in patients with poor glucometrics. Neither admission glucose >140 mg/ dL or diabetes status was predictive of total costs or LOS. In multivariate linear regression, only MBG ≥ 140 mg/dl was associated with increased LOS and total cost. Patients with persistent hyperglycemia also had higher 6 months all-cause readmission rates (51% vs 37%; p = 0.03). Conclusion: Persistent hyperglycemia (MBG > 140 mg/dL), but not admission glucose, was associated with increased LOS, total cost and readmission rates independent of diabetes status. Our study emphasizes the need to further examine the role of glycemic control in patients admitted with CHF.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Adigopula, S. , Feng, Y. , Babu, V. , Parperis, K. , Amoateng-Adjepong, Y. and Zarich, S. (2013) Hyperglycemia is associated with increased length of stay and total cost in patients hospitalized for congestive heart failure. World Journal of Cardiovascular Diseases, 3, 245-249. doi: 10.4236/wjcd.2013.32038.

References

[1] Malmberg, K., Norhammar, A., Wedel, H., et al. (1999) Glycometabolic state at admission: Important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: Long-term results from the diabetes and insulin-glucose infusion in acute myocardial infarction (DIGAMI) study. Circulation, 99, 2626-2632. doi:10.1161/01.CIR.99.20.2626
[2] Kosiborod, M., Inzucchi, S.E., Krumholz, H.M., et al. (2008) Glucometrics in patients hospitalized with acute myocardial infarction: Defining the optimal outcomesbased measure of risk. Circulation, 117, 1018-1027. doi:10.1161/CIRCULATIONAHA.107.740498
[3] Sung, J., Bochicchio, G.V., Joshi, M., et al. (2005) Admission hyperglycemia is predictive of outcome in critically ill trauma patients. The Journal of Trauma, 59, 80-83. doi:10.1097/01.TA.0000171452.96585.84
[4] Whitcomb, B.W., Pradhan, E.K., Pittas, A.G., et al. (2005) Impact of admission hyperglycemia on hospital mortality in various intensive care unit populations. Critical Care Medicine, 33, 2772-2777. doi:10.1097/01.CCM.0000189741.44071.25
[5] Krinsley, J.S. (2003) Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clinic, 78, 14711478. doi:10.4065/78.12.1471
[6] McAlister, F.A., Man, J., Bistritz, L., et al. (2003) Diabetes and coronary artery bypass surgery. Diabetes Care, 26, 1518-1524. doi:10.2337/diacare.26.5.1518
[7] Jones, K.W., Cain, A.S., Mitchell, J.H., et al. (2008) Hyperglycemia predicts mortality after CABG: Postoperative hyperglycemia predicts dramatic increases in mortality after coronary artery bypass graft surgery. Journal of Diabetes and Its Complications, 22, 365-370. doi:10.1016/j.jdiacomp.2007.05.006
[8] Barsheshet, A., Garty, M., Grossman, E., et al. (2006) Admission blood glucose level and mortality among hospitalized nondiabetic patients with heart failure. Archives of Internal Medicine, 166, 1613-1619. doi:10.1001/archinte.166.15.1613
[9] Berry, C., Brett, M., Stevenson, K., et al. (2008) Nature and prognostic importance of abnormal glucose tolerance and diabetes in acute heart failure. Heart, 94, 296-304. doi:10.1136/hrt.2006.110999
[10] Kosiborod, M., Inzucchi, S.E., Spertus, J.A., et al. (2009) Elevated admission glucose and mortality in elderly patients hospitalized with heart failure. Circulation, 119, 1899-1907. doi:10.1161/CIRCULATIONAHA.108.821843
[11] Adigopula, S., Babu, V., Konstantinos, M.P., et al. (2009) Hyperglycemia in heart failure patients is associated with increased length of stay and costs. Circulation, 120, S548.
[12] McKee, P.A., Castelli, W.P., McNamara, P.M., et al. (1971) The natural history of congestive heart failure: The Framingham study. The New England Journal of Medicine, 285, 1441-1446. doi:10.1056/NEJM197112232852601
[13] Held, C., Gerstein, H.C., Yusuf, S., et al. (2007) Glucose levels predict hospitalization for congestive heart failure in patients at high cardiovascular risk. Circulation, 115, 1371-1375. doi:10.1161/CIRCULATIONAHA.106.661405
[14] Newton, J.D. and Squire, I.B. (2006) Glucose and haemoglobin in the assessment of prognosis after first hospitalisation for heart failure. Heart, 92, 1441-1446. doi:10.1136/hrt.2005.080895
[15] Bhatia, V., Wilding, G.E., Dhindsa, G., et al. (2004) Association of poor glycemic control with prolonged hospital stay in patients with diabetes admitted with exacerbation of congestive heart failure. Endocrine Practice, 10, 467-471. doi:10.4158/EP.10.6.467
[16] Gebreegziabher, Y., McCullough, P.A., Bubb, C., et al. (2008) Admission hyperglycemia and length of hospital stay in patients with diabetes and heart failure: A prospective cohort study. Congestive Heart Failure, 14, 117120. doi:10.1111/j.1751-7133.2008.07569.x

  
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