In-hospital and 1-year mortality associated with diabetes in patients with acute heart failure: Results from the ESC-HFA Heart Failure Long-Term Registry

Giovanni Targher, Marco Dauriz, Cécile Laroche, Pier Luigi Temporelli, Mahmoud Hassanein, Petar M. Seferovic, Jaroslaw Drozdz, Roberto Ferrari, Stephan Anker, Andrew Coats, Gerasimos Filippatos, Maria G. Crespo-Leiro, Alexandre Mebazaa, Massimo F. Piepoli, Aldo Pietro Maggioni, Luigi Tavazzi

Research output: Contribution to journalArticle

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Abstract

Aims: The aim of this study was to evaluate the in-hospital and 1-year prognostic impact of diabetes and elevated blood glucose levels at hospital admission in patients with acute heart failure (HF). Methods and results: We studied a multinational cohort of 6926 hospitalized patients with acute HF enrolled in the European Society of Cardiology (ESC) and Heart Failure Association (HFA) Long-Term Registry, of whom 49.4% (n = 3422) had known or previously undiagnosed diabetes (defined as self-reported history, or medication use, or fasting glucose levels ≥7.0mmol/L or haemoglobin A1c ≥6.5%). Compared with those without diabetes, patients with known or previously undiagnosed diabetes had higher cumulative rates of in-hospital mortality, 1-year mortality, and 1-year HF re-hospitalization that occurred independently of multiple clinical risk factors: in-hospital mortality [6.8 vs. 4.4%; adjusted hazard ratio (HR) 1.774; 95% confidence interval (CI) 1.282-2.456, P < 0.001], 1-year all-cause mortality (27.5 vs. 24%; adjusted HR 1.162; 95% CI 1.020-1.325, P = 0.024), and 1-year hospital re-admissions for HF (23.2 vs. 18.5%; adjusted HR 1.320; 95% CI 1.139-1.530, P < 0.001). Moreover, elevated admission blood glucose concentrations were powerfully prognostic for in-hospital mortality, but not for 1-year mortality or re-hospitalizations, in both patients with and without diabetes. Conclusions: Among patients hospitalized for acute HF, the presence of diabetes is independently associated with an increased risk of in-hospital mortality, 1-year all-cause mortality, and 1-year re-hospitalizations for HF, underscoring the need for more effective and personalized treatments of diabetes in this particularly high-risk patient population.

Original languageEnglish
Pages (from-to)54-65
Number of pages9
JournalEuropean Journal of Heart Failure
DOIs
Publication statusPublished - Jan 2017

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Cardiology
Registries
Heart Failure
Hospital Mortality
Mortality
Hospitalization
Confidence Intervals
Blood Glucose
Patient Admission
Fasting
Hemoglobins
History
Glucose
Population

Keywords

  • Acute heart failure
  • Co-morbidities
  • Diabetes
  • Observational outcome study

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

In-hospital and 1-year mortality associated with diabetes in patients with acute heart failure : Results from the ESC-HFA Heart Failure Long-Term Registry. / Targher, Giovanni; Dauriz, Marco; Laroche, Cécile; Temporelli, Pier Luigi; Hassanein, Mahmoud; Seferovic, Petar M.; Drozdz, Jaroslaw; Ferrari, Roberto; Anker, Stephan; Coats, Andrew; Filippatos, Gerasimos; Crespo-Leiro, Maria G.; Mebazaa, Alexandre; Piepoli, Massimo F.; Maggioni, Aldo Pietro; Tavazzi, Luigi.

In: European Journal of Heart Failure, 01.2017, p. 54-65.

Research output: Contribution to journalArticle

Targher, G, Dauriz, M, Laroche, C, Temporelli, PL, Hassanein, M, Seferovic, PM, Drozdz, J, Ferrari, R, Anker, S, Coats, A, Filippatos, G, Crespo-Leiro, MG, Mebazaa, A, Piepoli, MF, Maggioni, AP & Tavazzi, L 2017, 'In-hospital and 1-year mortality associated with diabetes in patients with acute heart failure: Results from the ESC-HFA Heart Failure Long-Term Registry', European Journal of Heart Failure, pp. 54-65. https://doi.org/10.1002/ejhf.679
Targher, Giovanni ; Dauriz, Marco ; Laroche, Cécile ; Temporelli, Pier Luigi ; Hassanein, Mahmoud ; Seferovic, Petar M. ; Drozdz, Jaroslaw ; Ferrari, Roberto ; Anker, Stephan ; Coats, Andrew ; Filippatos, Gerasimos ; Crespo-Leiro, Maria G. ; Mebazaa, Alexandre ; Piepoli, Massimo F. ; Maggioni, Aldo Pietro ; Tavazzi, Luigi. / In-hospital and 1-year mortality associated with diabetes in patients with acute heart failure : Results from the ESC-HFA Heart Failure Long-Term Registry. In: European Journal of Heart Failure. 2017 ; pp. 54-65.
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abstract = "Aims: The aim of this study was to evaluate the in-hospital and 1-year prognostic impact of diabetes and elevated blood glucose levels at hospital admission in patients with acute heart failure (HF). Methods and results: We studied a multinational cohort of 6926 hospitalized patients with acute HF enrolled in the European Society of Cardiology (ESC) and Heart Failure Association (HFA) Long-Term Registry, of whom 49.4{\%} (n = 3422) had known or previously undiagnosed diabetes (defined as self-reported history, or medication use, or fasting glucose levels ≥7.0mmol/L or haemoglobin A1c ≥6.5{\%}). Compared with those without diabetes, patients with known or previously undiagnosed diabetes had higher cumulative rates of in-hospital mortality, 1-year mortality, and 1-year HF re-hospitalization that occurred independently of multiple clinical risk factors: in-hospital mortality [6.8 vs. 4.4{\%}; adjusted hazard ratio (HR) 1.774; 95{\%} confidence interval (CI) 1.282-2.456, P < 0.001], 1-year all-cause mortality (27.5 vs. 24{\%}; adjusted HR 1.162; 95{\%} CI 1.020-1.325, P = 0.024), and 1-year hospital re-admissions for HF (23.2 vs. 18.5{\%}; adjusted HR 1.320; 95{\%} CI 1.139-1.530, P < 0.001). Moreover, elevated admission blood glucose concentrations were powerfully prognostic for in-hospital mortality, but not for 1-year mortality or re-hospitalizations, in both patients with and without diabetes. Conclusions: Among patients hospitalized for acute HF, the presence of diabetes is independently associated with an increased risk of in-hospital mortality, 1-year all-cause mortality, and 1-year re-hospitalizations for HF, underscoring the need for more effective and personalized treatments of diabetes in this particularly high-risk patient population.",
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AU - Targher, Giovanni

AU - Dauriz, Marco

AU - Laroche, Cécile

AU - Temporelli, Pier Luigi

AU - Hassanein, Mahmoud

AU - Seferovic, Petar M.

AU - Drozdz, Jaroslaw

AU - Ferrari, Roberto

AU - Anker, Stephan

AU - Coats, Andrew

AU - Filippatos, Gerasimos

AU - Crespo-Leiro, Maria G.

AU - Mebazaa, Alexandre

AU - Piepoli, Massimo F.

AU - Maggioni, Aldo Pietro

AU - Tavazzi, Luigi

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N2 - Aims: The aim of this study was to evaluate the in-hospital and 1-year prognostic impact of diabetes and elevated blood glucose levels at hospital admission in patients with acute heart failure (HF). Methods and results: We studied a multinational cohort of 6926 hospitalized patients with acute HF enrolled in the European Society of Cardiology (ESC) and Heart Failure Association (HFA) Long-Term Registry, of whom 49.4% (n = 3422) had known or previously undiagnosed diabetes (defined as self-reported history, or medication use, or fasting glucose levels ≥7.0mmol/L or haemoglobin A1c ≥6.5%). Compared with those without diabetes, patients with known or previously undiagnosed diabetes had higher cumulative rates of in-hospital mortality, 1-year mortality, and 1-year HF re-hospitalization that occurred independently of multiple clinical risk factors: in-hospital mortality [6.8 vs. 4.4%; adjusted hazard ratio (HR) 1.774; 95% confidence interval (CI) 1.282-2.456, P < 0.001], 1-year all-cause mortality (27.5 vs. 24%; adjusted HR 1.162; 95% CI 1.020-1.325, P = 0.024), and 1-year hospital re-admissions for HF (23.2 vs. 18.5%; adjusted HR 1.320; 95% CI 1.139-1.530, P < 0.001). Moreover, elevated admission blood glucose concentrations were powerfully prognostic for in-hospital mortality, but not for 1-year mortality or re-hospitalizations, in both patients with and without diabetes. Conclusions: Among patients hospitalized for acute HF, the presence of diabetes is independently associated with an increased risk of in-hospital mortality, 1-year all-cause mortality, and 1-year re-hospitalizations for HF, underscoring the need for more effective and personalized treatments of diabetes in this particularly high-risk patient population.

AB - Aims: The aim of this study was to evaluate the in-hospital and 1-year prognostic impact of diabetes and elevated blood glucose levels at hospital admission in patients with acute heart failure (HF). Methods and results: We studied a multinational cohort of 6926 hospitalized patients with acute HF enrolled in the European Society of Cardiology (ESC) and Heart Failure Association (HFA) Long-Term Registry, of whom 49.4% (n = 3422) had known or previously undiagnosed diabetes (defined as self-reported history, or medication use, or fasting glucose levels ≥7.0mmol/L or haemoglobin A1c ≥6.5%). Compared with those without diabetes, patients with known or previously undiagnosed diabetes had higher cumulative rates of in-hospital mortality, 1-year mortality, and 1-year HF re-hospitalization that occurred independently of multiple clinical risk factors: in-hospital mortality [6.8 vs. 4.4%; adjusted hazard ratio (HR) 1.774; 95% confidence interval (CI) 1.282-2.456, P < 0.001], 1-year all-cause mortality (27.5 vs. 24%; adjusted HR 1.162; 95% CI 1.020-1.325, P = 0.024), and 1-year hospital re-admissions for HF (23.2 vs. 18.5%; adjusted HR 1.320; 95% CI 1.139-1.530, P < 0.001). Moreover, elevated admission blood glucose concentrations were powerfully prognostic for in-hospital mortality, but not for 1-year mortality or re-hospitalizations, in both patients with and without diabetes. Conclusions: Among patients hospitalized for acute HF, the presence of diabetes is independently associated with an increased risk of in-hospital mortality, 1-year all-cause mortality, and 1-year re-hospitalizations for HF, underscoring the need for more effective and personalized treatments of diabetes in this particularly high-risk patient population.

KW - Acute heart failure

KW - Co-morbidities

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KW - Observational outcome study

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