Diabetes Mellitus in Advanced Heart Failure |
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| Affiliation: | 1. Department of Cardiovascular Medicine;2. Department of Quantitative Health Sciences;3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery;4. Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota;1. From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;2. Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas;3. Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;4. Departments of Medicine and Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland;5. Division of Pediatric Cardiac Surgery, Monroe Carell Jr. Children''s Hospital at Vanderbilt, Nashville, Tennessee;6. Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee;7. Division of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;8. Texas Heart Institute, Houston, Texas;1. The Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern, Dallas, Texas;2. Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas;3. Regeneron Genetics Center, Tarrytown, New York;4. The Pauly Heart Center, Department of Internal Medicine, Virginia Commonwealth School of Medicine, Richmond, Virginia;1. Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai, China;2. Cardiovascular Research institution, Shanghai Jiao Tong University School of Medicine. Shanghai, China;3. Department of Cardiology, The General Hospital of Shenyang Military. Shenyang, China;4. Department of Cardiology, Zhejiang Hospital. Hangzhou, China;5. Structural valve program, Montreal Heart Institute, Québec, Canada;6. Visiting Professor Program, Shanghai Jiao Tong University School of Medicine. Shanghai, China;7. Institut Coeur Poumon, CHRU de Lille. Lille, France;1. Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, NY, USA;2. Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA;1. Department of Physiology and Pathophysiology, Wroclaw Medical Physiology, Wroclaw, Poland;2. Department of Cardiology, Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland;3. Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland;4. Centre for Heart Diseases, University Hospital in Wroclaw, Wroclaw, Poland;1. Toronto General Hospital Research Institute, Toronto, Ontario, Canada;2. Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada;3. Kidney Research Centre, Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada;4. Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut;5. Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Ontario, Canada;6. Instituto do Coracao, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;7. Banting and Best Diabetes Centre, Toronto, Canada;8. Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada;9. Department of Medicine, Division of Cardiology, Sinai Health System and Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada |
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| Abstract: | ![]()
BackgroundDiabetes mellitus is associated with increased rates of mortality in patients with less severe (stage C) heart failure (HF). The prevalence of diabetes and its complications in advanced (stage D) HF and their contributions to mortality risk are unknown.Methods and ResultsWe conducted a retrospective population-based cohort study of all adult residents of Olmsted County, Minnesota, who had advanced HF between 2007 and 2017. Patients with diabetes were identified by using the criteria of the Healthcare Effectiveness Data and Information Set. Diabetes complications were captured by using the Diabetes Complications Severity Index. Of 936 patients with advanced HF, 338 (36.1%) had diabetes. Overall, median survival time after development of advanced HF was 13.1 (3.9–33.1) months; mortality did not vary by diabetes status (aHR 1.06, 95% CI 0.90–1.25; P = 0.45) or by glycated hemoglobin levels in those with diabetes (aHR 1.01 per 1% increase, 95% CI 0.93–1.10; P = 0.82). However, patients with diabetes and 4 (aHR 1.24, 95% CI 0.92–1.67) or 5–7 (aHR 1.49, 95% CI 1.09–2.03) diabetes complications were at increased risk of mortality compared to those with ≤ 3 complications.ConclusionsMore than one-third of patients with advanced HF have diabetes. In advanced HF, overall prognosis is poor, but we found no evidence that diabetes is associated with a significantly higher mortality risk. |
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