The effect of diabetes on outcomes of patients with advanced heart failure in the BEST trial

Abstract

Diabetes worsens prognosis in patients with advanced HF, but this worsening appears to be limited to patients with ischemic cardiomyopathy. In advanced HF beta-blockade is effective in reducing major clinical end points in patients with and without diabetes.

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

“…In particular, the results of the GISSI‐HF trial contrast with those from other previously published clinical trials, including the SOLVD (Studies Of Left Ventricular Dysfunction) Prevention and Treatment trial, the DIG (Digitalis Investigation Group) trial, and the BEST (Beta‐Blocker Evaluation of Survival) trial,21, 22, 23 which have reported that the independent prognostic impact of DM, if any, on survival outcomes in patients with advanced HF might be confined only to those with ischemic cardiomyopathy. The OPTIMIZE‐HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with HF) registry also showed that patients with coexistent HF and DM had similar rates of in‐hospital and 3‐month postdischarge survival outcomes compared with those without DM 27.…”

“…The independent prognostic impact of DM on survival outcomes in patients with CHF has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting 4, 9, 20, 21, 22, 23, 24, 27, 28, 34. Similarly, few studies have investigated the prevalence of pre‐DM in patients with CHF and even fewer its clinical consequences (and with conflicting findings) 9, 14, 20, 24…”

“…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.…”

ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD – Summary

“…In the DIABHYCAR study, the combination of heart failure and T2DM resulted in a mortality rate 12-times-as great as in patients with T2DM but without heart failure (36 vs.3%). 282 BEST and Studies Of Left Ventricular Dysfunction (SOLVD) 283,285 reported T2DM as an independent predictor of mortality, mostly in ischaemic heart failure.…”

“…291,292 β-Blockers also reduce hospitalizations for heart failure in both DM and non-DM. 283,284,293,294 Despite this, T2DM subjects are less likely to be discharged from hospital on a β-blocker than non-DM with heart failure. 295 293,294,296,297 Mineralocorticoid receptor antagonists.…”