What is the clinical evidence from this study?

Study design: Observational. Population: Cardiovascular disease in diabetes. Intervention: Diagnosed diabetes vs. Adults without diabetes. Primary outcome: Age-adjusted hospitalization rate for acute coronary syndrome (ACS) (AAPC -4.6%, 95% CI -5.3, -3.8, p=<0.001).

What does this research mean for the field?

Between 1998 and 2014, age-adjusted hospitalization rates for acute coronary syndrome and other cardiovascular conditions declined significantly among U.S. adults with diabetes, although their rates remained two to four times higher than those without diabetes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 17, 2017

Declining Rates of Hospitalization for Selected Cardiovascular Disease Conditions Among Adults Aged ≥35 Years With Diagnosed Diabetes, U.S., 1998–2014

Q: What are the key findings of this study?

Between 1998 and 2014, age-adjusted hospitalization rates for acute coronary syndrome among U.S. adults with diabetes declined significantly by an average of 4.6% per year.

Q: What does this research mean for the field?

Between 1998 and 2014, age-adjusted hospitalization rates for acute coronary syndrome and other cardiovascular conditions declined significantly among U.S. adults with diabetes, although their rates remained two to four times higher than those without diabetes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Between 1998 and 2014, age-adjusted hospitalization rates for acute coronary syndrome among U.S. adults with diabetes declined significantly by an average of 4.6% per year.

Study Design

Type

Observational

Structured PICO

Population

Adults aged ≥35 years with diagnosed diabetes in the U.S.

Comparator

Adults aged ≥35 years without diabetes in the U.S.

Outcome

Hospitalization rates for acute coronary syndrome, cardiac dysrhythmia, heart failure, hemorrhagic stroke, and ischemic strokehard clinical

Between 1998 and 2014, hospitalization rates for major cardiovascular conditions declined significantly among US adults with diabetes, although they remained 2 to 4 times higher than in adults without diabetes.

Main Result

Effect estimate: AAPC -4.6% (95% CI -5.3, -3.8)

p-value: p=<0.001

Limitations

Health care practices changed during the study period
NIS samples hospital discharges, not individual persons, so repeat hospitalizations may be counted
Cannot distinguish persons with prior known CVD from those without
Estimates of diagnosed diabetes based on self-report, excluding undiagnosed or prediabetes
New diagnostic criteria for diabetes in 1997 may have included individuals with milder disease

Abstract

OBJECTIVE: Reductions in heart attack and stroke hospitalizations are well documented in the U.S. population with diabetes. We extended trend analyses to other cardiovascular disease (CVD) conditions, including stroke by type, and used four additional years of data. RESEARCH DESIGN AND METHODS: Using 1998-2014 National (Nationwide) Inpatient Sample (NIS) data, we estimated the number of discharges having acute coronary syndrome (ACS) (ICD-9 codes 410-411), cardiac dysrhythmia (427), heart failure (428), hemorrhagic stroke (430-432), or ischemic stroke (433.x1, 434, and 436) as first-listed diagnosis and diabetes (250) as secondary diagnosis. Hospitalization rates for adults aged ≥35 years were calculated using estimates from the population with and the population without diabetes from the National Health Interview Survey (NHIS) and age-adjusted to the 2000 U.S. standard population. Joinpoint regression was used to analyze trends and calculate an average annual percentage change (AAPC) with 95% confidence limits (CLs). RESULTS: From 1998 to 2014, in the population with diabetes, age-adjusted hospitalization rates declined significantly for ACS (AAPC -4.6% per year 95% CL -5.3, -3.8), cardiac dysrhythmia (-0.7% -1.1, -0.2), heart failure (-3.6% -4.6, -2.7), hemorrhagic stroke (-1.1% -1.4, -0.7), and ischemic stroke (-2.9% -3.9, -1.8). In the population without diabetes, rates also declined significantly for these conditions, with the exception of dysrhythmia. By 2014, rates in the population with diabetes population remained two to four times as high as those for the population without diabetes, with the largest difference in heart failure rates. CONCLUSIONS: CVD hospitalization rates declined significantly in both the population with diabetes and the population without diabetes. This may be due to several factors, including new or more aggressive treatments and reductions in CVD risk factors and CVD incidence.

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