Hospitalized heart failure patients with preserved vs. reduced ejection fraction in Dubai, United Arab Emirates: a prospective study

Aims Glucose abnormalities are associated with heart failure (HF), are increasingly prevalent, and may have an impact on outcome. Our aim was to evaluate the effect of fasting glucose levels on clinical outcome in patients with HF. Methods and results Patients with a diagnosis of HF as coded at a health maintenance organization in Jerusalem, Israel were evaluated retrospectively. Impaired fasting glucose (IFG) was defined as fasting plasma glucose levels between 100 and 125 mg/dL. All patients were followed for cardiac‐related hospitalizations and death. A total of 6067 HF patients were included. Mean follow‐up was 487 days; mean age 75 ± 13 years; 48% of the patients (n = 2,942) had diabetes; and 11.9% (n = 722) had IFG. Overall survival during the follow‐up was 82.5%. Cox regression analysis after adjustment for significant predictors including age, gender, ischaemic heart disease, hyperlipidaemia, hypertension, body mass index, glomerular filtration rate, serum urea, sodium, and haemoglobin levels demonstrated that patients with diabetes and IFG had a very similar outcome. Both were significant predictors of reduced survival compared with ‘normal’ glucose levels (fasting glucose levels between 92 and 99 mg/dL) [diabetes, hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.08–1.86, P = 0.01; IFG, HR 1.55, 95% CI 1.13–2.15, P < 0.01]. Diabetes and IFG were also predictors of increased cardiac‐related hospitalizations (diabetes HR 1.31, 95% CI 1.16–1.48, P < 0.001; IFG, HR 1.17, 95% CI 1.00–1.35, P < 0.05). Conclusions Diabetes and IFG are common in patients with HF and have a similar effect on outcome including survival and cardiac hospitalizations. Glucose abnormalities including subclinical diabetes confer significant risk in patients with HF.

Section: Diabetes and Clinical Outcome In Heart Failurecontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 78%

Impaired fasting glucose: a predictor of reduced survival in patients with heart failure

Gotsman

Shauer

Lotan

et al. 2014

“…Interestingly, the prospective multicentre heart function assessment registry trial in Saudi Arabia (HEARTS) reported a 61% prevalence of diabetes in patients hospitalized with acute HF. 15 In addition, a recent study on acute HF from Dubai, United Arab Emirates demonstrated a prevalence of 66% in an Arab population, 16 and a recent report from Saudi Arabia demonstrated a 63% prevalence of diabetes in patients hospitalized with acute HF. 17 The above prevalence figures are close to the prevalence of diabetes found in the Arab HF population in the present study.…”

Section: Discussionmentioning

confidence: 99%

Ethnic disparity in the clinical characteristics of patients with heart failure

Gotsman

Avishai-Eliner

Jabara

et al. 2015

Aims The characteristics of heart failure (HF) patients of different ethnic backgrounds in Israel are unknown. The purpose of the present study was to evaluate the clinical characteristics of Arab vs. Jewish patients with chronic HF. Methods and results Patients with a diagnosis of HF at a health maintenance organization in Jerusalem, Israel were evaluated. All patients were followed for cardiac‐related hospitalizations and death. The study cohort included 6773 HF patients; 4991 (74%) were Jewish and 1735 (26%) were Arab. The overall prevalence of HF in the Jewish vs. Arab population was similar (women, 4.3% vs. 4.7%, respectively, P = 0.06; men, 5.3% vs. 5.2%, P = 0.61). The prevalence of HF was significantly higher in Arab subjects of younger age groups (50–70 years). Arabs developed HF on average 10 years earlier and had a significantly higher rate of diabetes and obesity. Standard of care based on prescribed medications was similar between the ethnic groups. Glucose and cholesterol levels were higher in the Arab cohort. Mortality was similar between the groups at median follow‐up (576 days), with the exception of cardiovascular hospitalizations and death that were higher in Arab men. Conclusions Arab subjects develop HF at a much younger age compared with their Jewish counterparts and have a higher prevalence of diabetes and obesity. Standard of care and clinical outcome are comparable. Implementation of prevention programmes to reduce risk factors, particularly diabetes and obesity, may help reduce the disparity between Arabs and Jews.

“…Studies conducted in non‐Western heart failure cohorts outside North America and Europe demonstrated substantial variations in clinical characteristics, outcomes, and aetiology of heart failure. A recent heart failure cohort study conducted in the United Arab Emirates revealed that Middle Eastern patients are 10 years younger and have a higher prevalence of DM compared with developed countries . Compared with Caucasian populations, South Asian patients with systolic heart failure present earlier with frequent hospital admissions.…”

Section: Discussionmentioning

confidence: 99%

“…A recent heart failure cohort study conducted in the United Arab Emirates revealed that Middle Eastern patients are 10 years younger and have a higher prevalence of DM compared with developed countries. 29 Compared with Caucasian populations, South Asian patients with systolic heart failure present earlier with frequent hospital admissions. Despite having high prevalence of diabetes and hypertension, they have lower mortality compared with their Caucasian counterparts.…”

Section: Diabetes In Acute Heart Failure Patientsmentioning

confidence: 99%

Predictors of mortality in acute heart failure: interaction between diabetes and impaired left ventricular ejection fraction

Allen

Chia³

et al. 2014

Aim The aim of this study was to test the hypothesis that diabetes modifies the risk of mortality in acute heart failure patients, especially in patients with impaired LVEF, and that impaired LVEF in turn modifies the risk of mortality in diabetic patients. Methods and results We studied 2121 patients with acute heart failure admitted at two centres in Singapore from 1 January 2008 to 31 December 2009. The date of the last follow‐up was 31 December 2011, with a median follow‐up time (interquartile range) of 914 (442–1190) days. Cox regression was used to estimate hazard ratios for all‐cause mortality in patients with LVEF ≥50%, LVEF 30–49%, and LVEF <30% relative to diabetic status. Impaired LVEF (<50%) in the presence of diabetes substantially increased the risk of mortality compared with non‐diabetics with LVEF <50%. The adjusted hazard ratio (aHR) and 95% confidence interval (CI) for diabetic patients with an LVEF of 30–49% (1.46, 95% 1.18–1.81) was not statistically different from the aHR in non‐diabetic patients with severely impaired LVEF of <30% (1.38, 95% CI 1.09–1.75) (P = 0.644). The deleterious effects of diabetes seemed to be confined to acute heart failure patients with impaired LVEF, as the mortality rate in patients with LVEF >50% was not increased. Other clinical predictors of mortality were ageing, prior myocardial infarction, systolic blood pressure >140 mmHg, creatinine ≥250 µmol/L, haemoglobin <9.0 g/dL, and prior stroke/transient ischaemic attack. Conclusion The interaction of diabetes and impaired LVEF in acute heart failure patients significantly amplifies the deleterious effects of each as distinct disease entities.