Long-term mortality is increased in patients with undetected prediabetes and type-2 diabetes hospitalized for worsening heart failure and reduced ejection fraction

Abstract

Background: We assessed the prevalence of newly diagnosed prediabetes and type-2 diabetes mellitus (T2DM), and their impact on long-term mortality in patients hospitalized for worsening heart failure with reduced ejection fraction (HFrEF). Methods: We included patients hospitalized with HFrEF and New York Heart Association (NYHA) functional class II-III. Baseline two-hour oral glucose tolerance test was used to classify patients as normoglycaemic or having newly diagnosed prediabetes or T2DM. Outcomes included post-discharge all-cause and cardiovascular mortality during the median follow-up of 2.1 years. Results: At baseline, out of 150 patients (mean-age 57 AE 12 years; 88% male), prediabetes was diagnosed in 65 (43%) patients, and T2DM in 29 (19%) patients. These patients were older and more often with NYHA class III symptoms, but distribution of comorbidities was similar to normoglycaemic patients. Taking normoglycaemic patients as a reference, adjusted risk of all-cause mortality was significantly increased both in patients with prediabetes (hazard ratio, 2.6; 95% confidence interval (CI), 1.1-6.3; p ¼ 0.040) and in patients with T2DM (hazard ratio, 5.3; 95% CI, 1.7-15.3; p ¼ 0.023). Likewise, both prediabetes (hazard ratio, 2.9; 95% CI, 1.1-7.9; p ¼ 0.041) and T2DM (hazard ratio, 9.7; 95% CI 2.9-36.7; p ¼ 0.018) independently increased the risk of cardiovascular mortality compared with normoglycaemic individuals. There was no interaction between either prediabetes or T2DM and heart failure aetiology or gender on study outcomes (all interaction p-values > 0.05). Conclusions: Newly diagnosed prediabetes and T2DM are highly prevalent in patients hospitalized for worsening HFrEF and NYHA functional class II-III. Importantly, they impose independently increased long-term risk of higher all-cause and cardiovascular mortality.

European Society of Cardiology/Heart Failure Association position paper on the role and safety of new glucose‐lowering drugs in patients with heart failure

“…Type 2 diabetes mellitus (T2DM) is common (∼20-40%) in patients with heart failure (HF), 1 and is associated with worse symptoms and quality of life, a greater burden of HF hospitalisation, and higher mortality rates compared to patients without T2DM. [2][3][4][5][6][7] Increased levels of glycosylated haemoglobin (HbA 1c ) have been associated with increased morbidity and mortality in patients with T2DM and HF not receiving treatment with glucose-lowering drugs. 8,9 However, once treatment of T2DM has been initiated, this relationship may no longer be linear.…”

Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

“…Atrial fibrillation (AF) and type 2 diabetes mellitus (T2DM) commonly coexist, and T2DM is a recognized risk factor for thromboembolism in patients with AF . In the general population, T2DM has been associated with an increased risk of heart failure (HF) and mortality independently of other clinical characteristics . Specifically, in patients with AF, the impact of T2DM is less well established concerning complications beyond stroke and systemic embolism.…”

“…2 In the general population, T2DM has been associated with an increased risk of heart failure (HF) and mortality independently of other clinical characteristics. [3][4][5][6] Specifically, in patients with AF, the impact of T2DM is less well established concerning complications beyond stroke and systemic embolism. Available data are conflicting, since several studies have suggested higher risks of all-cause mortality, [7][8][9] HF events (e.g.…”

Undiagnosed dysglycemia in patients hospitalized for worsening heart failure: not so sweet after all

“…Reporting separately prediabetes and newly diagnosed T2DM is one of the most important strengths of the data. 1 To the best of our knowledge, this is the first study to report the prevalence of prediabetes in a real-life observational cohort of consecutive patients hospitalized for worsening HF. Previously, three RCTs enrolling HFrEF patients [10][11][12] have reported a lower prevalence of prediabetes, but all of these studies included ambulatory HF patients (Figure 1).…”

“…This article refers to 'Long-term mortality is increased in patients with undetected prediabetes and type 2 diabetes hospitalized for worsening heart failure and reduced ejection fraction' by Pavlovic´and colleagues, published in this issue of the journal. 1 The syndrome of heart failure (HF) is the clinical manifestation of diverse underlying cardiac and noncardiac comorbidities, resulting in a heterogeneous patient population ranging from stable and ambulatory to decompensated and hospitalized. 2 Among patients recently hospitalized for worsening HF, the mortality and readmission rates approach 27% and 44%, respectively, at 1 year.…”