Background/Purpose: Cardiovascular disease (CVD) risk is increased in SLE patients, compared to the general population and age- and sex-matched diabetes mellitus (DM) patients. Heart failure (HF) is the leading cause of hospitalizations in the U.S., and HF risk is elevated among DM patients compared to those without DM. Given the elevated CVD risk in SLE patients, we investigated rates and risks of HF hospitalization among SLE patients and age- and sex-matched DM and general Medicaid patients.

Methods: We used Medicaid Analytic eXtract (MAX) data, containing billing claims for Medicaid patients from the 29 most populated US states, 2007-2010. We identified both SLE and DM patients, ages 18-65, using >3 ICD-9 codes for SLE or DM, each separated by >30 days. Index date was the date of the 3^rd diagnosis code. We matched each SLE patient at index date to 2 DM patients and 4 general Medicaid patients without SLE or DM, by age at index date and sex. (The general Medicaid cohort had non-SLE, non-DM ICD-9 codes on date of SLE index date.) We required a baseline period of 6 months of continuous Medicaid enrollment prior to the index date for all patients. Subjects were followed from index date until death, disenrollment or end of follow-up. We used ICD-9 codes to identify HF as primary or secondary hospital discharge diagnosis and calculated rates of first HF hospitalization event per 1,000 person-years for each cohort. We used Cox proportional hazard models to calculate hazard ratios (HR) for first HF hospitalization events. In a secondary analysis, we excluded those with baseline HF.

Results: 40,212 SLE patients were matched to 80,424 DM and 160,848 general patients. In all cohorts, 92% were female, and mean age was 40.3 (+12.1) years. Mean follow up was 1.8 (+1.1) years for SLE, 1.8 (+1.1) years for DM, and 1.6 (+1.2) years for general patients. Baseline CVD was prevalent in 18% of SLE, 13% of DM and 1% of non-SLE, non-DM cohorts, and baseline HF was prevalent in 6% of SLE, 5% of DM and <1% of non-SLE, non-DM patients. HF hospitalization rates per 1,000-person years were similar in SLE and DM, but lower in the general population (Table). Adjusted HRs for first HF hospitalizations were higher among DM (HR 4.0, 95% CI 3.6-4.3) and SLE (HR 2.4, 95% CI 2.2-2.7) patients compared to non-SLE, non-DM patients. When patients with baseline HF were excluded, the HR for first HF hospitalizations were similar between SLE (HR 2.5, 95% CI 2.3-2.8) and DM (HR 2.7, 95% CI 2.4-2.9).

Conclusion: SLE and age- and sex-matched DM patients had significantly higher rates of HF hospitalization than age- and sex-matched general (non-SLE, non-DM) Medicaid patients. The adjusted risk of first HF hospitalization was also over twice as high in both SLE and DM patients than in patients without either condition, which has important implications for improving clinical care for SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/heart-failure-hospitalizations-among-sle-and-diabetes-mellitus-patients-compared-to-the-general-u-s-medicaid-population/