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Eur J Heart Fail. 2017 Jan;19(1):54-65. doi: 10.1002/ejhf.679. Epub 2016 Oct 28.

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.

Author information

1
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
2
EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France.
3
Cardiology Division, IRCCS Fondazione Salvatore Maugeri, Veruno, NO, Italy.
4
Alexandria University, Alexandria, Egypt.
5
Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia.
6
Department of Cardiology, Medical University, Lodz, Poland.
7
Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Italy.
8
Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.
9
Monash University, Australia and University of Warwick, Coventry, UK.
10
Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain.
11
Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario, Universitario A Coruna, CHUAC, La Coruna, Spain.
12
Inserm 942, Hôpital Lariboisière, Université Paris Diderot, Paris, France.
13
Department of Cardiology, Polichirurgico Hospital G. da Saliceto, Piacenza, Italy.
14
ANMCO Research Center, Florence, Italy.
15
Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.

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 ≥7.0 mmol/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.

KEYWORDS:

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

PMID:
27790816
DOI:
10.1002/ejhf.679
[Indexed for MEDLINE]
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