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

M. Dauriz, G. Targher, P. L. Temporelli, D. Lucci, L. Gonzini, G. L. Nicolosi, R. Marchioli, G. Tognoni, R. Latini, F. Cosmi, L. Tavazzi, A. P. Maggioni, GISSI-HF Investigators

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND: The independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre-DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre-DM on survival outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. METHODS AND RESULTS: We assessed the risk of all-cause death and the composite of all-cause death or cardiovascular hospitalization over a median follow-up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI-HF trial, who were stratified by presence of DM (n=2852), pre-DM (n=2013), and non-DM (n=2070) at baseline. Compared with non-DM patients, those with DM had remarkably higher incidence rates of all-cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non-DM patients and those with pre-DM. Cox regression analysis showed that DM, but not pre-DM, was associated with an increased risk of all-cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28-1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13-1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all-cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02-1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01-1.29, respectively). CONCLUSIONS: Presence of DM was independently associated with poor long-term survival outcomes in patients with chronic heart failure. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.
Original languageEnglish
Pages (from-to)10.1161/JAHA.116.005156
JournalJournal of the American Heart Association
Volume6
Issue number7
DOIs
Publication statusPublished - Jul 5 2017

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Prediabetic State
Diabetes Mellitus
Heart Failure
Cause of Death
Survival
Registries
Hemoglobins
Hospitalization
Randomized Controlled Trials
Regression Analysis
Outcome Assessment (Health Care)
Clinical Trials
Incidence

Keywords

  • chronic heart failure
  • diabetes mellitus
  • glycemic control
  • heart failure
  • mortality
  • prediabetes

Cite this

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. / Dauriz, M.; Targher, G.; Temporelli, P. L.; Lucci, D.; Gonzini, L.; Nicolosi, G. L.; Marchioli, R.; Tognoni, G.; Latini, R.; Cosmi, F.; Tavazzi, L.; Maggioni, A. P.; Investigators, GISSI-HF.

In: Journal of the American Heart Association, Vol. 6, No. 7, 05.07.2017, p. 10.1161/JAHA.116.005156.

Research output: Contribution to journalArticle

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title = "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",
abstract = "BACKGROUND: The independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre-DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre-DM on survival outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. METHODS AND RESULTS: We assessed the risk of all-cause death and the composite of all-cause death or cardiovascular hospitalization over a median follow-up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI-HF trial, who were stratified by presence of DM (n=2852), pre-DM (n=2013), and non-DM (n=2070) at baseline. Compared with non-DM patients, those with DM had remarkably higher incidence rates of all-cause death (34.5{\%} versus 24.6{\%}) and the composite end point (63.6{\%} versus 54.7{\%}). Conversely, both event rates were similar between non-DM patients and those with pre-DM. Cox regression analysis showed that DM, but not pre-DM, was associated with an increased risk of all-cause death (adjusted hazard ratio, 1.43; 95{\%} CI, 1.28-1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95{\%} CI, 1.13-1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all-cause death: adjusted hazard ratio, 1.21; 95{\%} CI, 1.02-1.43; and composite end point: adjusted hazard ratio, 1.14; 95{\%} CI, 1.01-1.29, respectively). CONCLUSIONS: Presence of DM was independently associated with poor long-term survival outcomes in patients with chronic heart failure. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.",
keywords = "chronic heart failure, diabetes mellitus, glycemic control, heart failure, mortality, prediabetes",
author = "M. Dauriz and G. Targher and Temporelli, {P. L.} and D. Lucci and L. Gonzini and Nicolosi, {G. L.} and R. Marchioli and G. Tognoni and R. Latini and F. Cosmi and L. Tavazzi and Maggioni, {A. P.} and GISSI-HF Investigators",
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TY - JOUR

T1 - 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

AU - Dauriz, M.

AU - Targher, G.

AU - Temporelli, P. L.

AU - Lucci, D.

AU - Gonzini, L.

AU - Nicolosi, G. L.

AU - Marchioli, R.

AU - Tognoni, G.

AU - Latini, R.

AU - Cosmi, F.

AU - Tavazzi, L.

AU - Maggioni, A. P.

AU - Investigators, GISSI-HF

N1 - LR: 20180122; CI: (c) 2017; ClinicalTrials.gov/NCT00336336; JID: 101580524; OTO: NOTNLM; 2017/07/07 06:00 [entrez]; 2017/07/07 06:00 [pubmed]; 2017/07/07 06:00 [medline]; epublish

PY - 2017/7/5

Y1 - 2017/7/5

N2 - BACKGROUND: The independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre-DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre-DM on survival outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. METHODS AND RESULTS: We assessed the risk of all-cause death and the composite of all-cause death or cardiovascular hospitalization over a median follow-up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI-HF trial, who were stratified by presence of DM (n=2852), pre-DM (n=2013), and non-DM (n=2070) at baseline. Compared with non-DM patients, those with DM had remarkably higher incidence rates of all-cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non-DM patients and those with pre-DM. Cox regression analysis showed that DM, but not pre-DM, was associated with an increased risk of all-cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28-1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13-1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all-cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02-1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01-1.29, respectively). CONCLUSIONS: Presence of DM was independently associated with poor long-term survival outcomes in patients with chronic heart failure. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.

AB - BACKGROUND: The independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre-DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre-DM on survival outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. METHODS AND RESULTS: We assessed the risk of all-cause death and the composite of all-cause death or cardiovascular hospitalization over a median follow-up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI-HF trial, who were stratified by presence of DM (n=2852), pre-DM (n=2013), and non-DM (n=2070) at baseline. Compared with non-DM patients, those with DM had remarkably higher incidence rates of all-cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non-DM patients and those with pre-DM. Cox regression analysis showed that DM, but not pre-DM, was associated with an increased risk of all-cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28-1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13-1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all-cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02-1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01-1.29, respectively). CONCLUSIONS: Presence of DM was independently associated with poor long-term survival outcomes in patients with chronic heart failure. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.

KW - chronic heart failure

KW - diabetes mellitus

KW - glycemic control

KW - heart failure

KW - mortality

KW - prediabetes

U2 - e005156 [pii]

DO - e005156 [pii]

M3 - Article

VL - 6

SP - 10.1161/JAHA.116.005156

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 7

ER -