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

Abstract

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.

Mortality outcome and predictive risk factors for death in patients with heart failure and reduced ejection fraction who declined implantable cardioverter defibrillator implantation in Singapore

“…We have shown that diabetes is an independent risk factor for death in this group of patients with depressed LVEF who declined ICD implantation for primary prevention. This finding is consistent with prior studies in diabetic patients with cardiomyopathy . Go et al demonstrated the synergistic deleterious effect of diabetes and impaired ejection fraction.…”

“…The outcome of 2121 patients with acute heart failure presenting to two centers in Singapore from 1 January 2008 to 31 December 2009, with a median follow‐up of 914 (442‐1190) days, was studied. Diabetic patients with impaired ejection fraction (<50%) were found to have higher mortality rates than their nondiabetic counterparts with similar ejection fraction …”

Diabetes, impaired fasting glucose, and heart failure: Its not all about the sugar

“…Work by Go et al 11 and Gotsman et al 12 attempts to address these issues (summarized in table 1). These studies corroborate previous work and reveal a high prevalence of CAD and associated risk factors, such as hypertension, peripheral vascular disease, and obesity in patients with HF.…”

Perspectives on reducing mortality attributed to acute myocardial infarction among patients with type 2 diabetes mellitus in multicenter randomized trials

“…исследования [59] показали, что у больных СД2, перенес-ших ОИМ, снижение ФВЛЖ менее 50% в 1,46 раза повы-шает летальность. Летальность возрастает и у пациентов с НУО, у которых после ОИМ более чем на 2/3 снижается ФВЛЖ.…”