Heart failure among US nursing home residents with diabetes mellitus.

BACKGROUND

Type 2 diabetes mellitus is associated with an increased risk of developing heart failure. However, few recent studies have examined the characteristics of older adults living in US nursing homes with heart failure and diabetes mellitus. This study is important for clinical practice and public health action plans for heart failure.

OBJECTIVE

To estimate the prevalence of, and factors associated with, heart failure in long-stay nursing home residents with diabetes mellitus.

METHODS

We conducted a cross-sectional study using the US 2016 Minimum Data Set data consisting of all residents with diabetes aged ≥65 years in Medicare/Medicaid certified nursing homes (n = 297,570). Diabetes mellitus and heart failure were operationalized using the resident's transfer notes at admission and the progress notes during admission through physical examination findings and current treatment orders.

RESULTS

Among all residents with diabetes, 26.4% had heart failure. Increasing age of residents, and comorbidities including coronary artery disease (aOR: 1.34; 95% CI: 1.31-1.37), end stage renal disease (aOR: 1.30; 95% CI: 1.26-1.35), and chronic obstructive pulmonary disease (aOR: 1.60; 95% CI: 1.57-1.63) were associated with a higher odds of heart failure.

CONCLUSIONS

This is one of the first U.S studies to examine the prevalence and factors associated with heart failure in nursing home residents with diabetes mellitus. It highlights a clinically complex population with multiple comorbid conditions. Future research is needed to understand the pharmacological management of these residents and the extent to which appropriate management can improve quality of life for a medically vulnerable population.