Impact of Diabetes on Epidemiology, Treatment, and Outcomes of Patients With Heart Failure

Dei, Alessandra; Khan, Sadiya S.; Butler, Javed; Mentz, Robert J.; Bonow, Robert O.; Avogaro, Angelo; Tschöepe, Diethelm; Doehner, Wolfram; Greene, Stephen J.; Senni, Michele; Gheorghiade, Mihai; Fonarow, Gregg C.

doi:10.1016/j.jchf.2014.08.004

Cited by 280 publications

(187 citation statements)

References 54 publications

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“…It is recommended that patients with HF-REF and diabetes mellitus are treated with ACEi/angiotensin receptor blocker and β-blockers, supplemented with MRAs if symptoms persist [21,37,38,39,40,41,42,43]. Outpatients with stable HF have a similar response to established HF treatment, irrespective of whether they have diabetes mellitus or not [44]. However, recent trials with novel therapies suggest that HF patients with diabetes might be more prone to developing adverse effects and that drugs may have different effects on HF patients with and without diabetes mellitus [45,46].…”

Section: Discussionmentioning

confidence: 99%

Prevalent Diabetes Mellitus: Mortality and Management in Norwegian Heart Failure Outpatients

Stubnova

Os²,

Grundtvig³

et al. 2016

Cardiology

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Objectives: Heart failure (HF) patients with diabetes mellitus experience poor prognosis. We assessed the independent predictive effect of prevalent diabetes mellitus on all-cause mortality in HF outpatients. Furthermore, we investigated if optimized HF medication differed in diabetic versus nondiabetic patients. Methods: From 6,289 patients included in the Norwegian HF registry during 2000-2012, 724 diabetic HF outpatients were propensity-score-matched with nondiabetic HF outpatients (1:1), based on 21 measured baseline variables. Baseline characteristics, measured comorbidities and medication were balanced in the matched sample. Results: Diabetes was not an independent predictor of all-cause mortality in the propensity-matched analyses (hazard ratio 1.041; 95% confidence interval 0.875-1.240). No interactions were found between the prognostic impact of diabetes and the strata renal function, systolic function or etiology of chronic HF. Diabetic HF outpatients were independently prescribed higher doses of β-blockers and loop diuretics (both p < 0.001) and were more prone to receive statins (p = 0.003) than nondiabetics. Conclusions: Prevalent diabetes mellitus was not an independent predictor of all-cause mortality in HF outpatients. Explanations other than tight glycemic control should be assessed to improve the prognosis of diabetic HF outpatients. The more intensive, optimized HF medication for diabetic HF outpatients may, to a certain degree, explain our results.

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Section: Discussionmentioning

confidence: 99%

Prevalent Diabetes Mellitus: Mortality and Management in Norwegian Heart Failure Outpatients

Stubnova

Os²,

Grundtvig³

et al. 2016

Cardiology

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“…Willey et al (2014) established that hypertension and diabetes have important effects on the burden of stroke, especially in individuals b 80 years of age and Hispanics. In addition, Dei Cas et al (2015) reported that the frequency of patients with heart failure and DM will increase with the general aging of the population. A specific cellular type involved with the development of CVD is the endothelial cell.…”

Section: Dm Cardiovascular Disease (Cvd) and Agingmentioning

confidence: 99%

Circulating cell-free mitochondrial DNA as the probable inducer of early endothelial dysfunction in the prediabetic patient

Alvarado-Vásquez¹

2015

Experimental Gerontology

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“…The prevalence of DM in patients with heart failure (HF) is extremely high (occurring in up to 40–45% of these patients) 7, 8. Not surprisingly, the burden of morbidity and mortality associated with CHF and DM represents, to date, a major challenge for the prospective sustainability of contemporary healthcare systems 8, 9, 10, 11…”

Section: Introductionmentioning

confidence: 99%

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

Dauriz

Targher

Temporelli

et al. 2017

JAHA

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BackgroundThe independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre‐DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐DM on survival outcomes in the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial.Methods and ResultsWe assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI‐HF trial, who were stratified by presence of DM (n=2852), pre‐DM (n=2013), and non‐DM (n=2070) at baseline. Compared with non‐DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐DM patients and those with pre‐DM. Cox regression analysis showed that DM, but not pre‐DM, was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01–1.29, respectively).ConclusionsPresence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.

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Impact of Diabetes on Epidemiology, Treatment, and Outcomes of Patients With Heart Failure

Cited by 280 publications

References 54 publications

Prevalent Diabetes Mellitus: Mortality and Management in Norwegian Heart Failure Outpatients

Prevalent Diabetes Mellitus: Mortality and Management in Norwegian Heart Failure Outpatients

Circulating cell-free mitochondrial DNA as the probable inducer of early endothelial dysfunction in the prediabetic patient

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

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