medwireNews: People who develop diabetes after hospitalization for heart failure (HHF) have a significantly greater risk for death than people who do not have or develop diabetes, study findings indicate.
In addition, the team, led by Bochra Zareini, from the Herlev and Gentofte University Hospital in Copenhagen, Denmark, reports that mortality risk is also elevated among individuals with diabetes at the time of HHF, but to a lesser degree.
Writing in Cardiovascular Diabetology, Zareini and co-authors say: “We hope our findings will aid clinicians in assessing important subgroups among patients with HF in need of close monitoring and supervision of co-existing diabetes illness.”
The study included 104,522 patients with a first HHF between 2003 and 2014. Of these, 19% had diabetes at baseline, and 10% developed new-onset diabetes during a mean 3.9 years of follow-up.
At the time of HHF, individuals with new-onset or prevalent diabetes were slightly younger than those without diabetes (70 and 74 vs 77 years, respectively) and were more likely to be men (62 and 60 vs 54%).
Patients with new-onset diabetes had a higher prevalence of atrial fibrillation, cancer, and chronic obstructive pulmonary disease than those in the other two groups, whereas patients with prevalent diabetes had the highest rates of ischemic heart disease, hypertension and chronic kidney disease.
During the follow-up period, the incidence of new-onset diabetes steadily increased with time, from around two cases per 100 person–years in the first year post HHF to approximately three cases per 100 person–years by year 5 and four cases per 100 person–years at year 10.
Overall, 59% of patients died during the study with an event rate of 15.0 per 100 person–years. The mortality rates were highest among the people with new-onset diabetes, intermediate for those with prevalent diabetes and lowest among the people with no diabetes, at 21.5, 17.9, and 13.9 deaths per 100 person–years, respectively
After adjustment for age, sex, HF duration, educational level, and comorbidity, new-onset diabetes was associated with a significant 47% increased risk for death relative to patients without diabetes.
The risk increase was a significant 19% among the patients with prevalent diabetes at the time of HHF.
Zareini et al conclude: “Our study underlines the close and detrimental correlation between HF and diabetes and further studies are needed to explore the potential benefit of early diagnosis and improved management of diabetes in the setting of concomitant HF.”
By Laura Cowen
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Cardiovasc Diabetol 2019; doi:10.1186/s12933-019-0883-4