Discordant Short- and Long-Term Outcomes Associated With Diabetes in Patients With Heart Failure: Importance of Age and Sex

Abstract

Background-Diabetes and heart failure frequently coexist. Our aim was to assess the association between diabetes and short-and long-term outcomes in all patients admitted to the hospital for the first time with heart failure in Scotland between 1986 and 2003. Methods and Results-A total of 116 556 patients were studied, of whom 13% (nϭ15 161) had a diagnosis of diabetes.At 30 days, diabetes was associated with a lower case fatality. By 1 year, the association between diabetes and better outcome was reversed, and diabetes was a significant independent predictor of higher case fatality. The longer term risk of death associated with diabetes was greatest in younger patients. In patients aged 65 years or younger, the hazard ratio for mortality at 5 years associated with diabetes was 1.41 (95% CI, 1.31 to 1.52) for men and 1.64 (1.50 to 1.79) for women. The risk associated with diabetes was less in patients aged 75 years or older: a hazard ratio in men 1.16 (1.10 to 1.22) and in women 1.15 (1.10 to 1.20). In the younger age group the risk associated with diabetes was significantly greater in women than in men (Pϭ0.005 for diabetes-sex interaction). Diabetes was also a significant independent predictor of heart failure readmission, and again the risk was greatest in younger women. Conclusions-Although diabetes was associated with a lower case fatality at 30 days, by 1 year it was a significant independent predictor of higher case fatality. The risk associated with diabetes was greatest in young patients, and in young patients the risk was greatest in women. (Circ Heart Fail. 2008;1:234-241.)

Combining heart rate and systolic blood pressure to improve risk stratification in older patients with heart failure: Findings from the RICA Registry

“…In general established risk factors tracked the risk stratification gradient for HR and SBP except for diabetes and high BMI which were more frequent in the lower risk group which is different to previous observations [20][21][22] . High BMI is associated with a better prognosis in HF, and is also associated with diabetes and this may partially explain this observation 23 .…”

Prognostic Impact of Diabetes and Prediabetes on Survival Outcomes in Patients With Chronic Heart Failure: A Post‐Hoc Analysis of the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) Trial

“…Notably, a number of other observational registries and randomized, clinical trials that explored the prognostic role of DM per se on survival outcomes in patients with HF have often reported inconclusive or conflicting results,21, 22, 23, 24, 25, 26, 27, 28 suggesting the need for further studies. In addition, very few studies also explored the independent prognostic role of pre‐DM on survival outcomes in this particularly high‐risk patient population.…”

Absence of interaction of diabetes mellitus with chronic kidney disease on mortality in acute heart failure

“…Based on our prevalence rates for CKD (around 9%) and for DM (around 32%), for an estimated 10% in-hospital mortality rate, and according to a previously reported 50% higher mortality rate for CKD patients 4 and 16% lower mortality rate for the diabetic population, 9 we estimated that our sample size would have 80% statistical power to detect a CKD-by-DM interaction OR below 1.15 and ORs below 1.06 for main effects at a two-tailed type I error rate of 50.05.…”

“…Yet, some limitations of this study should be pointed out: we relied on administrative data, which might have included coding errors or low codification for some of the variables (i.e., obesity); however, we have extensively used this database for other research purposes, 21,22 and similar administrative databases have been used seeking results for hypotheses related to ours. 9 Data pertained to internal medicine departments and might not exactly reflect data from other different medical specialties. Residual unaccounted confounding might partly explain the significant associations, as we were not able to adjust for some possibly underreported conditions, such as functional status, socio-sanitary situation or cognitive status.…”

“…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.…”