OBJECTIVES: This longitudinal study aims to track a cohort of patients over a 3 year period to quantify the healthcare utilisation and cost for people with diabetes and co-morbid heart failure.

METHODS: We identified patients admitted to hospital in England with a primary diagnosis of HF (ICD-10 Codes I500, I501, I509) and a secondary diagnosis of diabetes (E10-E14) from Hospital Episode Statistics (HES) between October 2016 and April 2017. The earliest hospitalisation meeting the criteria was set as the index date. The total observational period (data availability) was April 2016 to January 2020, resulting in a minimum 6 month look back and 30 months follow up. Our results describe healthcare utilisation cost seen throughout the observational period, in addition to post index utilisation and cost alone

RESULTS: Throughout the observational period there were 221,844 hospital spells recorded; 37,856 day cases, 95,092 elective spells and 116,715 non elective spells. There were also 135,202 A&E attendances and 795,770 outpatient appointments. There were an average of 9 hospital spells per patient within the cohort, 55% of which were non-elective spells. There were also 795,770 outpatient appointments generated by the cohort. The total cost generated by the cohort observed was £575,779,776 with a mean per patient cost of £25,634. Post index non-elective admissions generated a total of 15,460 re-admissions within 28 days, accounting for between 0.6% and 23.58% of total non-elective admissions at CCG level. Analysis of post index admission related mortality at health system population level demonstrated a mean mortality rate of 4.7% (1.98% - 7.09%).

CONCLUSIONS: Comorbid HF and diabetes pose a high cost to the NHS, with substantial variation within England. 28-day re-admission, and inpatient mortality highlight the burden of these conditions. Further research is warranted to understand how hospital-level interventions may contribute to the effort to reduce both cost and inpatient mortality.