Impact of new-onset diabetes mellitus and glycemic control on the prognosis of heart failure patients: A propensity-matched study in the community☆
Introduction
Diabetes mellitus is a risk factor for heart failure [1], [2], [3], the incidence of heart failure increases proportionally to the glycosylated haemoglobin A1c (HbA1c) level, for each 1% increase in HbA1c, the risk of heart failure increases by 12% [1], [2], [3]. Conversely, heart failure patients are at increased risk for developing diabetes mellitus [1], [2], but the incidence of type 2 diabetes mellitus in patients with heart failure is not established. Studies assessing the role of diabetes mellitus and glycemic control on the prognosis of heart failure presented discordant results [1], [2], [3]. Although, poor glycemic control has been associated with increased risk for developing heart failure, the absolute increase in mortality with poor glycemic control is not clearly established [1], [2]. There are no data showing that tight blood glucose control improves the prognosis of heart failure patients with diabetes mellitus [1], [2].
Our objectives in this analysis were to assess the incidence of type 2 diabetes mellitus in patients with heart failure, and to evaluate the effect of new-onset diabetes mellitus and glycemic control on mortality and morbidity among patients with a first diagnosis of heart failure treated with a contemporary medical regimen (the GAMIC cohort) [4], [5].
Section snippets
Study design and patients
Prospective study of a cohort of patients diagnosed for the first time with heart failure and previously unknown type 2 diabetes mellitus (5314 patients) during a period of 9 years (1 January 2001 to 31 December 2009). The patients included are residents of a community of 271,437 inhabitants in the south of Spain, served by the Hospital Universitario Puerto Real, Cadiz. The GAMIC cohort comprises adults (≥ 14 years) diagnosed with heart failure (HF) according to the Framingham criteria [6].
Baseline characteristics of the patients
The mean age of the 5314 propensity score-matched patients with newly diagnosed HF was 71.8 ± 7.9 years, 2816 (53.0%) were women, and 2668 (50.2%) had HF with preserved systolic function. Baseline characteristics of patients diagnosed with HF with or without new-onset type 2 diabetes mellitus (DM), before and after propensity score-matching are shown in Table 1. Before matching, patients with DM were likely to be younger and sicker, with a higher burden of comorbidity. After matching, patients
Discussion
In this population-based propensity-matched study of patients with a first diagnosis of heart failure (the GAMIC cohort), we observed an increased mortality (all-cause and cardiovascular) and morbidity (hospitalizations and visits) in patients who developed new-onset type 2 diabetes mellitus, particularly in those with a mean glycosylated haemoglobin A1c higher than 7.0%. This higher mortality and morbidity was maintained independently of the gender, of the type of HF (systolic or,
Acknowledgments
To the members of the Group for the Integrated and Continuous Medical Attention of Cádiz (GAMIC), without whose work this paper could not have been written. To Prof. José Almenara for the performance of the statistical analyses and, to Royston Snart for his professional help in the translation of the manuscript into English. The authors of this manuscript have certified that they comply with the principles of ethical publishing in the International Journal of Cardiology.
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Grant support: This study has been carried out with the financial help of the Consejería de Innovación, Ciencia y Tecnología of the Junta de Andalucía (Group CTS-155), Spain.