Association between diabetes mellitus and post‐discharge outcomes in patients hospitalized with heart failure: findings from the EVEREST trial

Abstract

AimsWe evaluated the impact of diabetes mellitus (DM) and diabetic therapy on outcomes in patients with reduced ejection fraction (EF) after hospitalization for heart failure (HF). DM is prevalent in patients hospitalized with HF, yet inconclusive data exist on the post-discharge outcomes of this patient population. Methods and resultsPost-hoc analysis was performed on the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan) study, a randomized trial of patients hospitalized with HF (n ¼ 4133) with median followup of 9.9 months. DM status was determined from intake questionnaires and cross-verified by medication history. Univariate relationships were examined using x 2 test, t-test, and Wilcoxon tests. The two primary outcomes of (i) all-cause mortality (ACM) and (ii) cardiovascular mortality or HF hospitalization (CVM + HFH) were assessed for those with and without DM and by diabetic treatment strategy using log rank tests and multivariable Cox regression models. DM was present in 40% of participants. Patients with DM were more likely to have hypertension, coronary artery disease, and chronic kidney disease. Diabetes was associated with ACM and CVM + HFH (both P , 0.001). Following multivariate risk adjustment, DM was associated with ACM, but this estimate was imprecise [hazard ratio (HR) 1.16; 95% confidence interval (CI) 1.00-1.34] and remained associated with CVM or HFH (HR 1.17; 95% CI 1.04-1.31). Diabetic control strategy did not independently affect outcomes. ConclusionDiabetes is common in patients hospitalized for heart failure with a reduced EF. These patients have a higher postdischarge CVM and higher HF hospitalizations compared with patients with no diabetes. Different diabetic treatment regimens did not appear to influence post-discharge outcomes.--

A Randomized Controlled Study of Finerenone vs. Eplerenone in Japanese Patients With Worsening Chronic Heart Failure and Diabetes and/or Chronic Kidney Disease

“…N.S. had full access to all the data in the study and takes mellitus 24 have high morbidity and mortality despite current therapy, the MR may be an important therapeutic target in these vulnerable patients. ARTS-HF Japan was a small study designed to test the response to finerenone in Japanese patients.…”

Clinical profile of diabetic patients with heart failure admitted in tertiary care teaching hospital, Kishanganj, Bihar- An Observational Study

“…30 Another study revealed that 33% of all HF patients have concomitant DM and this number rises up to 40% in patients admitted with acute decompensated HF. 31 Sarma S et al 32 showed approximately 40% of hospitalized HF patients with low EF have DM. DM in hospitalized patients is associated with worse prognosis 32 , increased risk for combined CV mortality and HF-related hospitalization 33 , and longer hospital stay 31 , despite receiving care that is similar to that for patients without DM 34 although this paradigm is not a consistent finding.…”

“…31 Sarma S et al 32 showed approximately 40% of hospitalized HF patients with low EF have DM. DM in hospitalized patients is associated with worse prognosis 32 , increased risk for combined CV mortality and HF-related hospitalization 33 , and longer hospital stay 31 , despite receiving care that is similar to that for patients without DM 34 although this paradigm is not a consistent finding. Anaemia is also a common companion to diabetes and this is because of the high prevalence of chronic kidney disease in patients with diabetes, leading to functional erythropoietin deficiency.…”

The Bi-directional Impact of Two Chronic Illnesses: Heart Failure and Diabetes – A review of the Epidemiology and Outcomes

“…22 The diagnosis of diabetes in heart failure patients results in increased cardiovascular mortality, higher readmission rates 23 and increased hospital lengths of stay. 24 Data from ALLHAT (The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) demonstrated significantly higher risk for heart failure admissions or death in diabetics, nearly twice as high than in those patients without diabetes.…”