No abstract

No abstract

IntroductionDiabetes mellitus (DM) and heart failure (HF) are two common diseases that often co-exist.AimTo explore clinical characteristics, management strategies and rates of 3-year mortality among diabetic and non-diabetic patients hospitalised in a highly specialized interventional cardiology centre.Material and methodsWe used data from COMMIT-HF (COnteMporary Modalities In Treatment of Heart Failure), which is a single-centre, observational, prospective registry of patients with symptomatic chronic systolic HF (LVEF < 35%). Data collected included demographics, clinical characteristics, medical history, inpatient therapies and procedures. Follow-up was based on the information acquired from the national health-care provider.ResultsWe analysed 1397 patients out of the total of 1798 patients included in the COMMIT-HF registry between 2009 and 2013. We identified 595 (42.6%) diabetic and 802 (57.4%) non-diabetic patients. Compared to patients without DM, patients with type 2 DM had a higher rate of comorbidity. Frequency of death in patients with DM during the 3-year follow-up was significantly higher than in patients without DM (199 (33.4%) vs. 163 (20.3%), p < 0.0001, respectively).ConclusionsIn the analysed HF population representing patients receiving typical, everyday clinical care, the prevalence of DM is 42.6%. Diabetes mellitus has deleterious effects on renal function and symptoms as assessed by the New York Heart Association functional class. DM remains associated with increased frequency of death in patients with HF, in spite of recent pharmacological and device-based advances in HF management.

INTRODUCTION    Early identification of patients with advanced heart failure (HF) who are at higher risk of poor outcome is an important element of patient management, both from the medical and economic standpoint. OBJECTIVES    We sought to determine the association between hematologic parameters assessed on admission and within a 3‑year follow‑up in consecutive patients with advanced HF. We also investigated the association between baseline demographic and clinical data and mortality. PATIENTS AND METHODS    We analyzed the data of consecutive patients with advanced HF from the single‑center registry COMMIT‑HF. Patients with hematologic and autoimmune disorders, acute or chronic inflammatory diseases, malignant diseases, incomplete clinical and laboratory data, and those receiving glucocorticoids were excluded from the study. RESULTS    We analyzed 785 patients with advanced HF out of the total number of 1798 patients included in the COMMIT‑HF registry between 2009 and 2013. The mean (SD) age of the patients was 61.9 (12.4) years, and 76.8% of them were male. Diabetes (hazard ratio [HR], 1.46; 95% CI, 1.15-1.86; P = 0.002), elevated red blood cell distribution width (RDW; HR, 1.05; 95% CI, 1.04-1.07; P <0.0001), and a low relative lymphocyte count (RLC%; HR, 0.942; 95% CI, 0.928-0.956; P <0.0001) were shown to be independent predictors of death. CONCLUSIONS    Our study showed that diabetes is a strong independent predictor of death in patients with advanced HF. RDW and RLC% are simple, accurate, and widely available markers predicting mortality at 3 years in patients with advanced HF.

BACKGROUND An accurate assessment of prognosis is an important element of the management of patients with advanced heart failure (HF) and diabetes mellitus, because the cooccurrence of these 2 diseases has a particularly unfavorable effect on their course and treatment efficacy. AIMS The aim of the study was to determine the prognostic factors affecting survival in patients with HF and diabetes. METHODS This was a retrospective analysis of clinical and laboratory data of 367 consecutive patients with advanced HF (New York Heart Association classes III-IV) and diabetes, hospitalized in a tertiary referral center for interventional cardiology between 2009 and 2013. Patients with hematologic disorders, those treated with steroids, and those with incomplete clinical data were excluded. The endpoint of the study was all-cause death. RESULTS The mean (SD) age of patients was 63.3 (10.8) years; men constituted 75.7% of the study group. During a mean (SD) follow-up of 4.4 (1.3) years, the overall mortality rate was 53.7%. In a multivariate analysis, independent risk factors of death included atrial fibrillation (AF) (hazard ratio [HR], 1.57; 95% CI, 1.14-2.17; P <0.01), red blood cell distribution width (RDW) (HR, 1.05; 95% CI, 1.02-1.07; P <0.0001), and platelet-to-lymphocyte ratio (PLR) (HR, 1.01; 95% CI, 1.01-1.01; P <0.0001). CONCLUSIONS Our study showed that permanent AF and 2 hematologic parameters, RDW and PLR, are associated with an increased risk of death in a long-term follow-up in patients with advanced HF and concomitant diabetes.