Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

Polovina, Marija; Lund, Lars H.; Đikić, Dijana; Petrović‐Đorđević, Ivana; Krljanać, Gordana; Milinković, Ivan; Veljić, Ivana; Piepoli, Massimo F; Rosano, Giuseppe M.C.; Ristić, Arsen D.; Ašanin, Milika; Seferović, Petar

doi:10.1002/ejhf.1666

Cited by 27 publications

(22 citation statements)

References 63 publications

(149 reference statements)

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“…Competing-risk regression analysis showed that patients with DM did not exhibit a significant increase in hospitalizations for AF or HF related complications, in comparison with those without DM. This is in contrast to similar studies, in which DM significantly increased the long-term risk of hospitalization in patients with AF [24,25]. The analysis on major bleeding events did not correlate with the increased risk for bleeding in DM implied by the HAS-BLED score, possibly due to the sparse events.…”

Section: Discussioncontrasting

confidence: 99%

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Papazoglou

Κάρτας

Samaras

et al. 2021

Cardiovasc Diabetol

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Background There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF). Methods This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan–Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality and the composite outcome of CV death or hospitalization. Competing-risk regression analyses were performed to calculate the cumulative risk of stroke, major bleeding, AF- or HF-hospitalizations adjusted for the competing risk of all-cause death. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM. Results In total 1109 AF patients were included, of whom 373 (33.6%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.40 95% confidence intervals [CI] 1.11–1.75), CV mortality (aHR = 1.39, 95% CI 1.07–1.81), sudden cardiac death (aHR = 1.73, 95% CI 1.19–2.52), stroke (aHR = 1.87, 95% CI 1.01–3.45) and the composite outcome of hospitalization or CV death (aHR = 1.27, 95% CI 1.06–1.53). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values 7.6–8.2% being independent predictors of increased all-cause mortality, and values < 6.2% predicting significantly decreased all-cause and CV mortality. Conclusions The presence of DM on top of AF was associated with substantially increased risk for all-cause or CV mortality, sudden cardiac death and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates suggesting that optimal DM control could be associated with better clinical outcomes in AF patients with DM.

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Section: Discussioncontrasting

confidence: 99%

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Papazoglou

Κάρτας

Samaras

et al. 2021

Cardiovasc Diabetol

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show abstract

“…Competing-risk regression analysis showed that patients with DM did not exhibit a signi cant increase in hospitalizations for AF or HF related complications, in comparison with those without DM. This is in contrast to similar studies, in which DM signi cantly increased the long-term risk of hospitalization in patients with AF 24,25 . The analysis on major bleeding events did not correlate with the increased risk for bleeding in DM implied by the HAS-BLED score, possibly due to the sparse events.…”

Section: Discussioncontrasting

confidence: 99%

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Papazoglou

Κάρτας

Σαμαράς

et al. 2021

Preprint

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Background: There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF).Methods: This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan-Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality and the composite outcome of CV death or hospitalization. Competing-risk regression analyses were performed to calculate the cumulative risk of stroke, major bleeding, AF- or HF-hospitalizations adjusted for the competing risk of all-cause death. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM.Results: In total 1140 AF patients were included, of whom 373 (32.7%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR=1.40 95% confidence intervals [CI]: 1.11-1.75), CV mortality (aHR=1.39, 95% CI: 1.07-1.81), sudden cardiac death (aHR=1.73, 95% CI: 1.19-2.52), stroke (aHR=1.87, 95% CI: 1.01-3.45) and the composite outcome of hospitalization or CV death (aHR=1.27, 95% CI: 1.06-1.53). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values 7.6-8.2% being independent predictors of increased all-cause mortality, and values <6.2% predicting significantly decreased all-cause and CV mortality.Conclusions: The presence of DM on top of AF was associated with substantially increased risk for all-cause or CV mortality, sudden cardiac death and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates suggesting that optimal DM control could be associated with better clinical outcomes in AF patients with DM.

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“…Type 2 diabetes mellitus confers a greater risk of new onset HF, HF rehospitalization, and CV and all‐cause mortality, particularly when patients require insulin treatment and/or have concomitant conditions 46–51 …”

Section: Co‐morbiditiesmentioning

confidence: 99%

Heart failure in the last year: progress and perspective

et al. 2020

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Research about heart failure (HF) has made major progress in the last years. We give here an update on the most recent findings. Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM‐HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA‐HF and EMPEROR‐Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65–0.85; P < 0.001 and HR 0.75; 95% CI 0.65–0.86; P < 0.001, respectively]. Second, vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo (HR 0.90; 95% CI 0.82–0.98; P = 0.02). On the other hand, both the diagnosis and treatment of HF with preserved ejection fraction, as well as management of advanced HF and acute HF, remain challenging. A better phenotyping of patients with HF would be helpful for prognostic stratification and treatment selection. Further aspects, such as the use of devices, treatment of arrhythmias, and percutaneous treatment of valvular heart disease in patients with HF, are also discussed and reviewed in this article.

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Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

Cited by 27 publications

References 63 publications

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Heart failure in the last year: progress and perspective

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