Abstract 2092: Heart Failure Patients with Diabetes Have More Comorbidities and Self Care Problems
Background: Approximately 30 – 47% of heart failure (HF) patients have diabetes mellitus (DM) which is associated with increased risk for rehospitalization and death. Little data exist on psychological factors, physical symptoms, and comorbidities that could affect self care and outcomes in this population.
Purpose: To compare HF patients with and without diabetes on demographic, clinical and psychosocial factors associated with self-care and outcomes.
Methods: Participants (N = 212, 61 ±11 years old, 62% male, 25% African-American, 62% NYHA functional class III/IV, 37% with DM) from a larger study on nutrition and Body Mass Index (BMI) in HF completed clinical assessments, interviews and questionnaires. Variables and measures were: comorbidities; psychosocial factors of anxiety (Brief Symptom Inventory), depressive symptoms (Beck Depression Inventory-II), and social support (Perceived Social Support Scale); frequency and severity of HF symptoms (Symptom Status Questionnaire); and outcomes of functional status (Duke Activity Status Index; DASI ) and quality of life (MLHFQ). Hospitalizations after 12 months were obtained from medical record review and patient/family interview in a subset. Data were analyzed by t-tests, Chi-Square and nonparametric statistics.
Results: Patients with DM were older (63 ± 9 vs 60±12 years, p=.02), had higher BMI (32 ± 6.4 vs 29.4 ± 6.7 kg/m2, p=.003), and a greater proportion had coronary artery disease, stroke, and renal dysfunction (p=.01) than those without DM. Thirty-seven percent were receiving insulin therapy. Although no differences in psychosocial factors were found, those with DM reported greater symptom severity (13.7 ±6.7 vs 10.7 ± 6.9 p=.003), and exhibited lower DASI scores (11.4 ± 10.8 vs 15.8 ± 13, p=.001), and MLHFQ scores (45.1 ± 22 vs 38.5 ± 23, p=.04) as well as more total hospitalizations at 12 months (1.5 ± 2.8 vs .55 ± 1.1 p=.04, n=122) than those without DM.
Conclusion: HF patients with concomitant DM are at risk for more complex self care regimens due to increased comorbidities and symptom severity, and reduced functional status and quality of life with increased hospitalizations. These data may be useful in designing a comorbidity model of self management interventions to improve outcomes.