Hospitalization Economic Impact Of Type 2 Diabetes Mellitus Co-morbidity In Patients With Heart Failure

BackgroundHeart Failure(HF)is a serious and final stage of various heart diseases.It is an worldwide important challenge of the prevention and treatment of chronic cardiovascular diseases,bringing heavy burden to the social economy of various countries.Epidemiological data shows that the prevalence of HF in China has risen significantly in recent years as the aging process of society accelerates.The overall prognosis of HF patients is poor.The 5 year survival rate is comparable to that of some malignant tumors.Diabetes mellitus(DM)is also one of the most important causes of death.In the past 40 years,the prevalence of DM in China has soared from 0.67%in 1980 to 10.4%in 2013.The average medical expenditure of DM patients is 2.3 times higher than that of non-DM patients.The mortality rate of HF complicated by DM is higher,and DM is an independent risk factor for HF.In recent years,the population aging problem in China has become more and more prominent and the increase of the elderly population will lead to the continuous increase of HF patients.The prognosis of elderly patients with HF is extremely poor.Studies show that 80%of HF hospitalizations and 90%of HF-related deaths occur among patients aged in 65 years and older.In China,there are few studies related to the impact of type 2 diabetes mellitus(T2DM)on the incidence of hospitalization events in HF patients and all hospitalization expenses.There are also few detailed reports on the impact of age and T2DM on the hospitalization expenses of HF patients and whether there is interaction between the two.Therefore,based on the above problems,the design idea of this research is formed.Objectives(1)To study the impact of T2DM on the incidence and hospitalization expenses of HF patients during hospitalization;(2)To study the effect of age on the hospitalization expenses in HF patients,and to analyze the interaction between age and T2DM;(3)To explore the influencing factors of the incidence,hospitalization expenses and prolonged hospitalized course of HF patients during hospitalization.Subjects and methodsA retrospective cohort study was performed in the patients who were discharged from hospital from January 1,2012 to December 31,2012 and diagnosed as HF,and had a New York Heart Association functional class(NYHA)class Ⅱ or above.Exclusive criteria:Patients with congenital heart disease,dilated cardiomyopathy,hypertrophic obstructive cardiomyopathy,rheumatic heart disease and patients.discharged automatically.Patients combined with type 2 diabetes mellitus were identified through clear discharge diagnosis.Finally,A total of 480 cases were screened out.According to whether HF patients complicated by DM or not,they were divided into 2 groups:HF patients complicated by DM and HF patients without DM.The HF patients were divided into two groups according to whether they were treated with PCI or not:HF patients who did not receive PCI treatment and HF patients who received PCI treatment.In order to exclude the significant impact of PCI treatment on hospitalization expenses,the patients who did not have PCI treatment during the hospitalization were divided into non-DM group and DM group according to whether they were complicated by DM or not,and then divided into young and old groups according to the definition that older than 65 years old belong to elderly population.The general characteristics,incidence of complications,hospitalization time and hospitalization expenses of each group were compared using statistical method.Using the factorial variance analysis to study whether PCI and age interact with DM,respectively,in terms of hospitalization expenses and length of stay.Regression analysis was used to analyze the influencing factors of hospitalization expenses,prolonged hospitalization time and free-event survival during hospitalization.Results:(1)Comparison of clinical characteristics between DM group and non-DM group:there was no significant difference in sex ratio in DM group when compared with non-DM group(P>0.05).The average age of DM group was lower than that of non-DM group(P<0.05).Compared with the non-DM group,the SBP,cardiac function severity,and the level of NT-proBNP,TG,NEFA,WBC,BUN and FIB in DM group at admission and discharge were all increased(P<0.05).There was no significant difference in PCI implantation rate in DM group when compared with non-DM group(P>0.05).In terms of medication,the usage rate of diuretics,aldosterone receptor antagonists,digitalis and ARB drugs in DM group was higher than that in non-DM group(P<0.05).During the treatment of DM,there was more use of insulin(39.6%),sulfonylureas(21.3%),metformin(38.5%)and acarbose(38.5%)and less use of glinides(13.0%)and gllitazone(0.6%)in DM group.(2)Comparison of clinical characteristics between PCI treatment group and non-PCI treatment group:compared with the non-PCI group,the male ratio,weight,TG,RBC and PLT levels in the PCI group were higher(P<0.05),while the age,heart rate,severity of heart function,N-terminal pro-brain natriuretic peptide,uric acid and LDH levels were lower(P<0.05).In terms of medication,the application rate of diuretic,aldosterone receptor antagonist,and digitalis were significantly lower in the PCI group than that in the non-PCI group(P<0.05),while the application rate of lipid-regulating drugs such as statins and antiplatelet drugs were higher(P<0.05)in PCI group.(3)Comparison of clinical data between DM group and non-DM group in patients without PCI treatment:In HF patients who did not receive PCI treatment during hospitalization,there was no significant difference in gender ratio between DM group and non-DM group(P>0.05).Compared with non-DM group,the severity of cardiac functional grading,NT-proBNP,TG,WBC,monocyte,Cys-C and FIB levels in DM group were all increased(P<0.05),while the average age and HDL-C levels were lower(P<0.05).In terms of medication,compared with non-DM group,DM group had a higher usage rate of diuretics,aldosterone receptor antagonists,digitalis and ARB(P<0.05).(4)Comparison of clinical data between young group and elderly group in patients without PCI treatment:compared with the younger group,the proportion of females,systolic blood pressure on admission,severity of cardiac functional grading,erythrocyte hemoglobin distribution width,cystatin C and fibrinogen levels in the older group were higher(P<0.05),while the height,weight,body mass index,diastolic blood pressure on admission,level of TG,RBC and ALT were all lower(P<0.05)in the older group.In terms of medication,the application ratio of diuretics,calcium antagonists and nitrates in the elderly group was higher than that in the younger group(P<0.05).(5)Influence of DM on hospitalization expenses and hospitalization time of HF patients:the expenses of HF patients during hospitalization were mainly composed of western medication costs(62%),treatment expenses(15%),laboratory fee(11%),examination expenses(5%),bed fee(5%)and other expenses(2%).Compared with non-DM group,the western medication fee,daily western medication fee,laboratory fee and daily laboratory fee in DM group were significantly higher(P<0.05),but there was no significant difference in total hospitalization cost,total daily expenses,treatment fee,daily treatment fee and hospitalization days(P>0.05).(6)Influence of PCI treatment on hospitalization expenses and hospitalization time:The total hospitalization cost,total daily cost,treatment fee and daily treatment fee were significantly higher in PCI treatment group compared with the non-PCI group(P<0.05).Compared with non-PCI treatment group,the laboratory fee of PCI treatment group was lower(P<0.05),but the daily laboratory fee was higher(P<0.05).There was no significant difference in western medication costs in PCI treatment group when compared with the non-PCI treatment group(P>0.05),but the daily western medication costs was higher(P<0.05).Compared with non-PCI group,the hospitalization days in patients of PCI treatment group was significantly shorter(P<0.05).(7)Analysis of interaction between DM and PCI treatment:DM did not affect total hospitalization expenses and hospitalization days(P>0.05).PCI treatment significantly increased hospitalization expenses(P<0.05),and reduced hospitalization days(P<0.05).There was no interaction between DM and PCI in terms of total hospitalization expenses and hospitalization days(P>0.05).(8)Influence of DM on hospitalization events in HF patients:compared with non-DM group,the incidence of atrial arrhythmia in DM group was significantly higher(P<0.05),and the event free survival was significantly lower(P<0.05).Compared with non-DM group,there was no statistical significance of difference in the incidence of acute HF,ventricular arrhythmia,rescue and mortality in the DM group(P>0.05).(9)The effect of PCI on hospitalization events in patients with HF:there was no significant difference in the free-event survival in PCI group when compared with non-PCI patients(P>0.05).(10)The effect of DM on hospitalization costs and hospitalization time of patients without PCI treatment:in patients without PCI treatment,the total hospitalization costs,daily hospitalization costs,laboratory fees,daily laboratory fees,western medication costs and daily western medication costs in DM group were all higher than those in non-DM group(P<0.05).Compared with the non-DM group,there was no statistical significance of difference in hospitalization time between DM group and non-DM group(P>0.05).(11)Influence of age on hospitalization expenses and hospitalization time in patients without PCI treatment:among the patients without PCI treatment,compared with the young group,the elderly group had higher total hospitalization expenses,laboratory fees,western medicine fees and daily western medicine fees(P<0.05).There was no statistical significance of difference in daily hospitalization costs and daily laboratory fees in the elderly group when compared with the young group(P>0.05).Compared with the young group,the elderly group had a longer hospitalization time(P<0.05).(12)The analysis of interaction and simple effect between DM and age:in patients without PCI treatment,DM increased the total hospitalization costs of HF patients(P<0.05).Age has no significant difference in the total hospitalization expenses of HF patients(P>0.05).In terms of total hospitalization costs,there was no interaction between DM and age(P>0.05).In terms of hospitalization time,there was an interaction between DM and age(P<0.05).Age increased the hospitalization time of non-DM HF patients(P<0.05),while had no significant impact on hospitalization time of HF patients complicated by DM(P>0.05).DM could increase the hospitalization time of young HF patients(P<0.05),but there was no statistical significance of difference in the hospitalization time of elderly HF patients(P>0.05).(13)Stepwise multiple linear regression analysis of influencing factors of hospitalization expenses:PCI(β = 0.713,P<0.05),cardiac functional grading(β = 0.106,P<0.05),acute HF(β = 0.136,P<0.05),age(β = 0.139,P<0.05)and β-receptor blocker(β=-0.075,P<0.05)were the factors affecting total hospitalization expenses.PCI(β = 0.616,P<0.05),β-receptor blocker(β =-0.175,P<0.05),cardiac functional grading(β = 0.150,P<0.05),age(β = 0.143,P<0.05)were the influencing factors of total hospitalization expenses.PCI(β = 0.665,P<0.05),age(β = 0.145,P<0.05)and rescue(β = 0.133,P<0.05)were the factors affecting on daily treatment fee.Cardiac functional grading(β =0.116,P<0.05),acute HF(β = 0.182,P<0.05),age(β = 0.227,P<0.05),digitalis(β = 0.155,P<0.05),PCI treatment(β = 0.170,P<0.05),NT-proBNP(β = 0.132,P<0.05)and levosimendan(β = 0.130,P<0.05)were the influencing factors of western medication fee in hospitalization.PCI treatment(β = 0.369,P<0.05),digitalis(β = 0.158,P = 0.003),NT-proBNP(β = 0.173,P<0.05),age(β = 0.129,P<0.05),acute HF(β = 0.118,P<0.05)and new onset atrial arrhythmia(β =0.105,P<0.05)were the influencing factors of daily western medication fee.PCI(β =-0.222,P<0.05),cardiac functional grading(β=0.192,P<0.05),acute HF(P = 0.110,P<0.05)were the influencing factors of the hospitalization times.(14)Logistic regression analysis of prolonged hospitalization course and event free survival:age(OR = 1.033,95%CI:1.009-1.058,P<0.05)and acute HF(OR = 5.748,95%CI:1.114-29.647,P<0.05)were the independent risk factors for prolonged hospitalization course.PCI treatment(OR = 0.258,95%CI:0.111-0.599,P<0.05)was the protective factors to reduce the hospitalization time.LDH(OR = 0.994,95%CI:0.990-0.998,P<0.05),complicated by DM(OR = 0.299,95%CI:0.135-0.664,P<0.05),BUN(OR-0.915,95%CI:0.843-0.993,P<0.05),which were the risk factors for reducing event free survival rate of HF patients during the hospitalization.Conclusions1.DM increased western medication fee and laboratory fees for HF patients,increased the total hospitalization costs for HF patients who did not receive PCI during hospitalization,and increased the hospitalization days for young HF patients;Hospitalization expenses of elderly patients with HF increased and the hospitalization time was extended significantly.Therefore,early prevention and intervention of DM and HF can make significant benefits.2.The main influencing factors of hospitalization expenses of HF patients were PCI,cardiac functional grading,acute HF,age and use of β-blocker.Among them,PCI was the main factor to increase hospitalization expenses.The poor heart function,acute HF occurred during hospitalization and the older age leading to a higher expenses,and the application of p-blocker can reduce the hospitalization expenses.3.The main influencing factors of hospitalization time for HF patients were age,acute HF and PCI treatment,among which PCI treatment was the protective factor for shortening hospitalization time;age and acute HF were the risk factors for prolonging hospitalization time.4.The combination of DM,LDH and BUN elevation were important factors to reduce the event free survival of HF patients during hospitalization.