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Cardiovascular Endocrinology

MON-291 - Heart Failure Phenotype and Mortality in Diabetic Ketoacidosis

Monday, June 15, 2026
9:00 AM - 2:00 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Amna Khalid: No financial relationships to disclose


Introduction:
Diabetic ketoacidosis (DKA) is a life-threatening emergency associated with significant mortality. In patients with DKA and concomitant heart failure (HF), differences in outcomes between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) remain poorly characterized. This study examines in-hospital mortality in patients admitted with DKA stratified by HF phenotype.

Objective:
To evaluate differences in in-hospital mortality between patients with HFpEF and HFrEF admitted with DKA using a nationally representative database.

Methods:
We conducted a retrospective cohort study using the National Inpatient Sample (2015–2022). Adult patients admitted with a primary diagnosis of DKA were identified using ICD-10 codes and subgrouped by HFpEF or HFrEF. The primary outcome was in-hospital mortality. Secondary outcomes included arrhythmias, ICU-level care, intubation, cardiogenic shock, length of stay (LOS), total charges, and demographics. Multivariable survey-weighted logistic regression was used to adjust for confounders and generate adjusted odds ratios (aOR). Categorical variables were compared using chi-square analysis.

Results:
Among 1,461,434 DKA admissions, 3.22% (n=47,035) had a diagnosis of heart failure, of whom 44.0% had HFrEF and 56.0% had HFpEF. Patients with HFpEF were older (58.8 vs 55.6 years), more likely female (60.4% vs 41.6%), and had higher Charlson comorbidity scores (4.9 vs 4.6; p< 0.005 for all). On adjusted analysis, patients with HFrEF had significantly higher odds of in-hospital mortality compared to HFpEF (aOR 1.84, p< 0.005; 95% CI 1.3–2.5), with higher absolute mortality rates (2.27% vs 1.46%, p< 0.005). HFrEF was also associated with increased rates of ventricular tachycardia (3.8% vs 1.3%), ventricular fibrillation (0.46% vs 0.09%), cardiac arrest (1.8% vs 1.0%), intubation (5.4% vs 3.9%), and cardiogenic shock (2.3% vs 0.4%) (p < 0.005 for all). No significant differences were observed in LOS, total charges, or SES.

Conclusion:
Heart failure significantly increases in-hospital mortality among patients admitted with DKA, with outcomes strongly influenced by HF phenotype. Patients with HFrEF experience substantially higher mortality and markedly increased rates of malignant arrhythmias, cardiogenic shock, and respiratory failure compared to those with HFpEF, identifying HFrEF as a high-risk phenotype in DKA hospitalizations. Although overall mortality was lower in HFpEF, select subgroups, including females and patients with advanced kidney disease, demonstrated increased risk, suggesting heterogeneous vulnerability within HFpEF. These findings highlight heart failure phenotype, particularly HFrEF, as a critical determinant of adverse outcomes in DKA and underscore the need for early risk stratification and intensified monitoring in this population.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*