Clinical features, management and mortality in diabetic and non-diabetic patients with heart failure – observations from the COMMIT-HF registry

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.

Analysis of National Health and Insurance Registers for All-Cause Mortality in Patients with Heart Failure with and without Diabetes Mellitus in Poland in 2012

“…In this study, the overall mortality rate in the entire subpopulation of women with heart failure and diabetes was more than five times greater than for women with heart failure without diabetes. These findings are supported by previous studies that have shown a two-fold to a three-fold increased risk of mortality due to heart failure in the diabetic population [1,2,21,22,33].…”

“…The findings from the present study support recently published findings on the impact of diabetes mellitus on clinical outcomes in patients with heart failure due to ischemic and non-ischemic cardiac disease [2,3,[31][32][33][34]. In 2016, a study from the Swedish Heart Failure Registry (SwedeHF) analyzed patient data from 2003 to 2011 and showed that heart failure was a severe complication of type 2 diabetes mellitus [34].…”

“…Studies from North America and Western European countries have shown that patients with heart failure who also have diabetes mellitus have a two-fold to a three-fold higher risk of mortality due to cardiovascular disease compared with nondiabetic patients [1,2]. Heart failure affects between 0.4-2.0% of the general population, with the most common cause being ischemic heart disease (IHD) due to coronary artery atherosclerosis, which is exacerbated by diabetes [3,4].…”

“…In 2017, Siedlecki et al reported the findings from the COnteMporary Modalities In Treatment of Heart Failure (COMMIT-HF) registry study of mortality in patients with heart failure, with and without diabetes, and reported that the prevalence of diabetes was 42.6% [2]. Diabetes resulted in impaired renal function and cardiac function, and was associated with increased mortality in patients with heart failure, even with improvements in the management of heart failure [2]. A recent study from the USA that analyzed health insurance registry data showed that patients with heart failure and diabetes were at increased risk for rehospitalization and mortality due to heart failure [3].…”

Caregivers’ burden and other selected problems of patients treated for heart failure

“…It is also the most common cause of hospitalisation after the age of 65 years and the cause of the deaths of 60,000 Poles a year [1][2][3]. Heart failure is most often caused by coronary heart disease, previous myocardial infarction, hypertension, heart valve defects, alcoholism, obesity, and diabetes [4][5][6]. Among patients hospitalised with HF the prevalence of diabetes mellitus is 42.6% and remains associated with increased frequency of death in this population [4].…”