Perspective Review: Type 2 Diabetes and Readmission for Heart Failure

Abstract

Heart failure is a leading cause for hospitalisation and for readmission, especially in patients over the age of 65. Diabetes is an increasingly common companion to heart failure. The presence of diabetes and its associated comorbidity increases the risk of adverse outcomes and premature mortality in patients with heart failure. In particular, patients with diabetes are more likely to be readmitted to hospital soon after discharge. This may partly reflect the greater severity of heart disease in these patients. In addition, agents that reduce the chances of readmission such as β-blockers, renin-angiotensin-aldosterone system blockers, and mineralocorticoid receptor antagonists are underutilised because of the perceived increased risks of adverse drug reactions and other limitations. In some cases, readmission to hospital is precipitated by acute decompensation of heart failure (re-exacerbation) leading to pulmonary congestion and/or refractory oedema. However, it appears that for most of the patients admitted and then discharged with a primary diagnosis of heart failure, most readmissions are not due to heart failure, but rather due to comorbidity including arrhythmia, infection, adverse drug reactions, and renal impairment/reduced hydration. All of these are more common in patients who also have diabetes, and all may be partly preventable. The many different reasons for readmission underline the critical value of multidisciplinary comprehensive care in patients admitted with heart failure, especially those with diabetes. A number of new strategies are also being developed to address this area of need, including the use of SGLT2 inhibitors, novel nonsteroidal mineralocorticoid antagonists, and neprilysin inhibitors.

Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

“…Our findings are consistent with other studies on trends in LOS and 30DR in hospitalized patients with diabetes. A number of studies have found that patients with diabetes have overall higher LOS and/or 30DR [24][25][26][27][28][29][30][31][32] when compared to patients who do not have diabetes. Comino, et al reported that readmission rates in 23,779 study patients with diabetes were between 2-6 times higher than those who did not have diabetes [24].…”

Predictors for self‐management in older adults with type 2 diabetic nephropathy

“…Third, we did not analyse differences among various types of comorbidities with regard to patient self‐management behaviour. Patients with type 2 diabetic nephropathy have a higher risk of hospitalisation and re‐admission (Thomas, ). The sample population was recruited from same hospital, and the results might not be representative or generalisable to the whole nation.…”

“…Patients with type 2 diabetic nephropathy have a higher risk of hospitalisation and re-admission (Thomas, 2018). The sample population was recruited from same hospital, and the results might not be representative or generalisable to the whole nation.…”

“…Poor blood sugar control is likely to cause cardiovascular disease, deterioration of renal function and other complications (American Diabetes Association, 2019;LeRoith et al, 2019). Control of diabetic nephropathy requires self-management of the disease, including optimising blood sugar, which helps to reduce complications, as well as the provision of multifaceted care programmes by medical professionals to reduce disease progression, which can include complex drug treatment (Hahr & Molitch, 2015;Thomas, 2018). Patients with diabetes also may be at risk of developing hypoglycaemia or of re-admission (Thomas, 2018), and thus, active self-management and monitoring of renal function and blood glucose levels are extremely important (Hahr & Molitch, 2015;Keke et al, 2017;LeRoith et al, 2019;Thomas, 2018).…”

Impact of diabetes on mortality and rehospitalization in acute heart failure patients stratified by ejection fraction

“…Incidence of HF in diabetic patients is reported to be twice the rate when compared with those without diabetes. 6 Rate of readmissions is noted relatively high in HF patients with T2DM. 7 Early diagnosis and proper treatment plan are important to achieve favourable short-term and long-term outcomes.…”