Journal
EUROPEAN JOURNAL OF HEART FAILURE
Volume 15, Issue 2, Pages 194-202Publisher
WILEY
DOI: 10.1093/eurjhf/hfs153
Keywords
Heart failure; Diabetes mellitus; Outcomes; Insulin
Categories
Funding
- Otsuka Inc. (Rockville, MD, USA)
- Center for Cardiovascular Innovation (Northwestern University Feinberg School of Medicine, Chicago, IL, USA)
- Otsuka
- Abbott Laboratories
- Astellas
- AstraZeneca
- Bayer Schering Pharma AG
- Cardiorentis Ltd
- CorThera
- Cytokinetics
- CytoPherx Inc.
- DebioPharm S.A.
- Errekappa Terapeutici
- GlaxoSmithKline
- Ikaria
- Intersection Medical
- INC
- Johnson Johnson
- Medtronic
- Merck
- Novartis Pharma AG
- Ono Parmaceuticals USA
- Otsuka Pharmaceuticals
- Palatin Technologies
- Pericor Therapeutics
- Protein Design Laboratories
- Sanofi-Aventis
- Sigma Tau
- Solvay Pharmaceuticals
- Sticares InterACT
- Takeda Pharmaceuticals North America, Inc
- Trevena Therapeutics
- Takeda Pharmaceuticals North America, Inc.
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We evaluated the impact of diabetes mellitus (DM) and diabetic therapy on outcomes in patients with reduced ejection fraction (EF) after hospitalization for heart failure (HF). DM is prevalent in patients hospitalized with HF, yet inconclusive data exist on the post-discharge outcomes of this patient population. Post-hoc analysis was performed on the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan) study, a randomized trial of patients hospitalized with HF (n 4133) with median follow-up of 9.9 months. DM status was determined from intake questionnaires and cross-verified by medication history. Univariate relationships were examined using (2) test, t-test, and Wilcoxon tests. The two primary outcomes of (i) all-cause mortality (ACM) and (ii) cardiovascular mortality or HF hospitalization (CVM HFH) were assessed for those with and without DM and by diabetic treatment strategy using log rank tests and multivariable Cox regression models. DM was present in 40 of participants. Patients with DM were more likely to have hypertension, coronary artery disease, and chronic kidney disease. Diabetes was associated with ACM and CVM HFH (both P 0.001). Following multivariate risk adjustment, DM was associated with ACM, but this estimate was imprecise [hazard ratio (HR) 1.16; 95 confidence interval (CI) 1.001.34] and remained associated with CVM or HFH (HR 1.17; 95 CI 1.041.31). Diabetic control strategy did not independently affect outcomes. Diabetes is common in patients hospitalized for heart failure with a reduced EF. These patients have a higher post-discharge CVM and higher HF hospitalizations compared with patients with no diabetes. Different diabetic treatment regimens did not appear to influence post-discharge outcomes.
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