Heart failure hospitalization in patients with and without type 2 diabetes: A population-based retrospective cohort study

PURPOSE: Type 2 diabetes mellitus (T2DM) is a common comorbidity among patients with heart failure (HF). This study aims to describe how T2DM relates to HF hospitalization patterns across demographic groups and HF subtypes. METHODS: We conducted a population-based retrospective cohort study using 19 years of clinical data from Cerner Health Facts®, a nationwide electronic health record (EHR) database. Adult patients hospitalized with HF were identified using ICD-9/ICD-10 diagnosis codes and HF-related medications and were stratified by T2DM status. Measures included HF-related hospitalization count, length of first HF hospitalization, and age at first HF hospitalization. Comparisons were examined across HF subtypes (historically termed systolic, diastolic, other). Additionally, sensitivity analyses were conducted using alternative inclusion criteria to assess the robustness of the findings. RESULTS: We identified 137,785 HF patients from the EHR database, among whom 29.5% had T2DM. Overall HF hospitalization was more common in men than in women; however, diastolic HF was more prevalent among women and presented at older ages whereas systolic HF was more prevalent among men. Compared with patients without T2DM, patients with T2DM experienced higher HF hospitalization count (mean: 2.81 vs. 2.42, p < 0.001), and both longer stay (mean: 7.03 vs. 6.85 days, p < 0.001) and earlier age (mean: 68.9 vs. 70.4 years, p < 0.001) of initial HF hospitalization. Across HF subtypes, T2DM was more prevalent among patients with diastolic HF (31.4% diastolic vs. 29.5% systolic vs. 28.7% other), and patients with T2DM were younger at first HF hospitalization than those without T2DM, with the largest difference observed for diastolic HF (mean: 70.4 vs. 73.1 years, p < 0.001). CONCLUSIONS: In this large nationwide EHR cohort, T2DM was associated with more intensive HF hospitalization patterns and was more prevalent in the diastolic HF subtype. These findings highlight the relevance of diabetes status and HF subtype, in addition to demographic factors, in shaping HF-related healthcare utilization.