TY - JOUR
T1 - Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction
T2 - Insights from the MECKI Score database
AU - Paolillo, Stefania
AU - Salvioni, Elisabetta
AU - Perrone Filardi, Pasquale
AU - Bonomi, Alice
AU - Sinagra, Gianfranco
AU - Gentile, Piero
AU - Gargiulo, Paola
AU - Scoccia, Alessandra
AU - Cosentino, Nicola
AU - Gugliandolo, Paola
AU - Badagliacca, Roberto
AU - Lagioia, Rocco
AU - Correale, Michele
AU - Frigerio, Maria
AU - Perna, Enrico
AU - Piepoli, Massimo
AU - Re, Federica
AU - Raimondo, Rosa
AU - Minà, Chiara
AU - Clemenza, Francesco
AU - Bussotti, Maurizio
AU - Limongelli, Giuseppe
AU - Gravino, Rita
AU - Passantino, Andrea
AU - Magrì, Damiano
AU - Parati, Gianfranco
AU - Caravita, Sergio
AU - Scardovi, Angela B.
AU - Arcari, Luca
AU - Vignati, Carlo
AU - Mapelli, Massimo
AU - Cattadori, Gaia
AU - Cavaliere, Carlo
AU - Corrà, Ugo
AU - Agostoni, Piergiuseppe
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/10/15
Y1 - 2020/10/15
N2 - Background: The prognostic role of diabetes mellitus (DM) in heart failure (HF) patients is undefined, since DM is outweighed by several DM-related variables when confounders are considered. We determined the prognostic role of DM, treatment, and glycemic control in a real-life HF population. Methods: 3927 HF patients included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score database were evaluated with a median follow-up of 3.66 years (IQR 1.70–6.67). Data analysis considered survival between DM (n = 897) vs. non-DM (n = 3030) patients, and, in diabetics, between insulin (n = 304), oral antidiabetics (n = 479), and dietary only (n = 88) treatments. The role of glycemic control was evaluated grouping DM patients according to glycated hemoglobin (HbA1c): <7% (n = 266), 7.1–8% (n = 133), >8% (n = 149). All analyses were performed also adjusting for ejection fraction, renal function, hemoglobin, sodium, exercise peak oxygen uptake, and ventilation/carbon dioxide relationship slope. Study primary endpoint was the composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Secondary endpoints were cardiovascular and all causes death. Results: For all endpoints, upon adjustment for confounders, DM status and insulin treatment or dietary regimen were not significantly associated with adverse long-term prognosis compared to non-DM and oral antidiabetic treated patients, respectively. A worse prognosis was observed in HbA1c >8% patients (Log-Rank p < 0.001), even after correction for confounding factors. All results were replicated by hazard ratio analysis. Conclusion: In HF patients, DM, insulin treatment and dietary regimen are not adverse outcome predictors. The only condition related to long-term prognosis, considering potential confounders, is poor glycemic control.
AB - Background: The prognostic role of diabetes mellitus (DM) in heart failure (HF) patients is undefined, since DM is outweighed by several DM-related variables when confounders are considered. We determined the prognostic role of DM, treatment, and glycemic control in a real-life HF population. Methods: 3927 HF patients included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score database were evaluated with a median follow-up of 3.66 years (IQR 1.70–6.67). Data analysis considered survival between DM (n = 897) vs. non-DM (n = 3030) patients, and, in diabetics, between insulin (n = 304), oral antidiabetics (n = 479), and dietary only (n = 88) treatments. The role of glycemic control was evaluated grouping DM patients according to glycated hemoglobin (HbA1c): <7% (n = 266), 7.1–8% (n = 133), >8% (n = 149). All analyses were performed also adjusting for ejection fraction, renal function, hemoglobin, sodium, exercise peak oxygen uptake, and ventilation/carbon dioxide relationship slope. Study primary endpoint was the composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Secondary endpoints were cardiovascular and all causes death. Results: For all endpoints, upon adjustment for confounders, DM status and insulin treatment or dietary regimen were not significantly associated with adverse long-term prognosis compared to non-DM and oral antidiabetic treated patients, respectively. A worse prognosis was observed in HbA1c >8% patients (Log-Rank p < 0.001), even after correction for confounding factors. All results were replicated by hazard ratio analysis. Conclusion: In HF patients, DM, insulin treatment and dietary regimen are not adverse outcome predictors. The only condition related to long-term prognosis, considering potential confounders, is poor glycemic control.
KW - Diabetes mellitus
KW - Glycated hemoglobin
KW - Heart failure
KW - Prognosis
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U2 - 10.1016/j.ijcard.2020.04.079
DO - 10.1016/j.ijcard.2020.04.079
M3 - Article
C2 - 32360652
AN - SCOPUS:85085644821
VL - 317
SP - 103
EP - 110
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -