Acute heart failure in patients with diabetes mellitus: Clinical characteristics and predictors of in-hospital mortality

Parissis, John; Rafouli‐Stergiou, Pinelopi; Mebazaa, Alexandre; Ikonomidis, Ignatios; Bistola, Vasiliki; Nikolaou, Maria; Méas, T.; Delgado, Juan; Vilas-Boas, Fábio; Paraskevaidis, Ioannis; Anastasiou-Nana, Maria; Folláth, Ferenc

doi:10.1016/j.ijcard.2011.11.098

Cited by 55 publications

(54 citation statements)

References 49 publications

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“…Numerous clinical trials have demonstrated a frequent association of AHF and diabetes [3]. Diabetes in AHF may have been largely under-diagnosed resulting in underestimation of its prevalence.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with a new, first-time-seen diagnosis of AHF are more likely to present with acute pulmonary edema or cardiogenic shock, while decompensation of HF usually occurs with weight gain, exertional dyspnea, or orthopnea that start days or weeks before admission [2]. The demographic and clinical characteristics of both diabetics and non-diabetics with AHF are presented in Table 1 [3]. The incidence of HF hospitalizations due to AHF has tripled in the last three decades, owing to the aging population, improved survival of patients after acute myocardial infarction (due to interventional and surgical treatment), and improved medical and device therapies causing longer life-span of these patients [4].…”

Section: The Scope Of Clinical Problemmentioning

confidence: 99%

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The role of glycemia in acute heart failure patients

Milinković

Tešić

et al. 2014

Clinical Chemistry and Laboratory Medicine (CCLM)

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Acute heart failure (AHF) is one of the most important cardiovascular syndromes associated with high cardiovascular morbidity, and is the major cause of admission in emergency departments worldwide. The clinical complexity of AHF has significantly increased, mostly due to the comorbidities: diabetes, arterial hypertension, dyslipidemia, obesity, peripheral vascular disease, renal insufficiency and anemia. Numerous clinical trials have demonstrated a frequent association of AHF and diabetes. Since AHF is a very heterogeneous condition, it is important to identify clinical and laboratory parameters useful for risk stratification of these populations. Hyperglycemia may be one of the most convenient, since it is widely measured, easily interpreted, and inexpensive. Acute coronary syndrome (ACS), arrhythmias and poor compliance to chronic medications are considered to be the most frequent precipitating factors of AHF in diabetics. Several studies identified diabetes as the most prominent independent predictor of morbidity and mortality in both acute and chronic heart failure (HF) patients. The following parameters were identified as the independent predictors of in-hospital mortality in patients with AHF and diabetes: older age, systolic blood pressure < 100 mmHg, ACS, non-compliance, history of hypertension, left ventricular ejection fraction (LVEF) < 50%, serum creatinine > 1.5 mg/dL, marked elevation of natriuretic peptides, hyponatremia, treatment at admission without ACE inhibitors/ARBs/β-blockers, and no percutaneous coronary intervention (PCI) as a treatment modality. The most frequent cause of AHF is ACS, both with ST segment elevation (STEMI) or without (NSTEMI). Hyperglycemia is very common in these patients and although frequently unrecognized and untreated, has a large in-hospital and mortality significance.

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Section: Discussionmentioning

confidence: 99%

Section: The Scope Of Clinical Problemmentioning

confidence: 99%

The role of glycemia in acute heart failure patients

Milinković

Tešić

et al. 2014

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…PCI improves the prognosis of patients with ACS, 2,3,5 reducing the ischemic complications and the development of heart failure. 4,6,7 The advent of generalized primary PCI in the management of these patients 1 and the early response of the emergency medical services may have contributed to the change in profile of patients admitted to CCUs during the last years. 25 Little information is available regarding IMV requirements in patients with ACS.…”

Section: Discussionmentioning

confidence: 99%

Invasive mechanical ventilation in acute coronary syndromes in the era of percutaneous coronary intervention

Solé

Salazar-Mendiguchía

Lorente-Tordera

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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Percutaneous coronary intervention (PCI) has emerged during the last decades as one of the most important therapeutic tools in patients with acute coronary syndromes (ACS). 1 PCI improves the prognosis of patients with ACS, 2,3 reducing the incidence of ischaemic complications and heart failure, 4 especially in those patients at higher risk, 5-7 thus potentially changing the need for invasive mechanical ventilation (IMV) in this clinical scenario. Little information is available regarding the profile of patients with ACS requiring IMV in the current era. Most of the few published articles regarding this subject come from an era when PCI was not a widespread practice, [8][9][10][11][12] had different methodologies and analyzed quite different populations. [13][14][15] Our objective was to better define the characteristics of ACS patients requiring IMV, the relative frequency of each of the indications for IMV, their in-hospital management Invasive mechanical ventilation in acute coronary syndromes in the era of percutaneous coronary intervention Albert Ariza Solé, Joel Salazar-Mendiguchía, Victòria Lorente-Tordera, José C Sánchez-Salado, José González-Costello, Pedro Moliner-Borja, Joan A Gómez-Hospital, Nicolás Manito-Lorite, Ángel Cequier-Fillat Abstract Background: Percutaneous coronary intervention (PCI) improves prognosis in patients with acute coronary syndromes (ACS) reducing ischaemic complications and the development of heart failure, thus potentially changing invasive mechanical ventilation (IMV) requirements. Little information exists about patients with ACS requiring IMV in the current era. We aimed to analyze IMV requirements and characteristics of ACS patients treated under current recommendations (including a high rate of PCI). Methods: Baseline characteristics, indications for IMV, management and in-hospital and mid-term clinical course were analyzed prospectively in a consecutive series of patients with ACS admitted to a tertiary care hospital. Results: We included 1821 patients, of which 106 (5.8%) required IMV. Mean follow-up was 347 days. PCI was performed in 84% of cases. Patients with IMV had more comorbidities, worse left ventricular function and more unstable hemodynamic parameters on admission. In-hospital mortality in patients requiring IMV was 29%. These patients also had higher mid-term mortality (hazard ratio (HR) 6.58; 95% confidence interval (CI) 4.49−9.64; p 0.001). The most common indication for IMV was cardiopulmonary arrest (CA) (65; 61%), followed by pulmonary oedema (27; 26%) and shock (14; 13.2%). Patients with CA were younger, with better hemodynamic parameters at admission, more favourable coronary anatomy and higher rates of PCI. There were no significant differences in overall mortality between the three groups. The main cause of death in CA patients was persistent vegetative state. Conclusions: Mortality in patients with ACS requiring IMV remained high despite a high rate of PCI. Baseline characteristics, management and clinical course were different according to the rea...

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“…It has been reported that CKD 4 and worsening of baseline renal function 5 are associated with higher mortality rates in HF patients. Furthermore, although some studies had shown higher mortality rates in diabetic patients admitted for HF, [6][7][8] additional work has found lower mortality rates. 9, 10 Ritchie et al 11 described a higher mid-term mortality rate in ambulatory chronic HF patients with both CKD and DM.…”

Section: Introductionmentioning

confidence: 99%