BACKGROUND: Patients with diabetes have poorer outcomes after surgery in general. In this study, we assess the impact of diabetes on outcomes after left ventricular assist devices (LVAD) placement. METHODS AND RESULTS: Data on 222 patients (57 diabetics) who underwent Novacor LVAD placement between 1996 and 2003 were compared for outcomes among patients who did and did not have diabetes. Significant differences between the diabetics versus nondiabetics included age (56 +/- 8 versus 49 +/- 1 years, P < .01), ischemic heart failure etiology (61% versus 44%, P = .04), history of hypertension (56% versus 30%, P < .01), thoracotomy (42% versus 30%, P = .08), stroke (14% versus 5%, P = .03), and body weight (86 +/- 16 kg versus 80 +/- 17 kg, P = .03), respectively. Eighty-four patients died on LVAD support, 28 of whom were diabetic. Thirty, 180, and 365-day survival for diabetic versus nondiabetic patients was: 76.6%, 45.6%, and 30.4% for diabetics and 86.7%, 62.4%, and 47.1% for nondiabetics (P = .02 for 180 and 365-day morality). After controlling for other variables, patients with diabetes were at a higher risk of mortality (OR 1.76, 95%CI 1.05-2.94). No significant difference in survival was noted between insulin-dependent versus non-insulin-dependent diabetics. CONCLUSION: Patients with diabetes are at a higher risk of mortality after LVAD implantation.
BACKGROUND:Patients with diabetes have poorer outcomes after surgery in general. In this study, we assess the impact of diabetes on outcomes after left ventricular assist devices (LVAD) placement. METHODS AND RESULTS: Data on 222 patients (57 diabetics) who underwent Novacor LVAD placement between 1996 and 2003 were compared for outcomes among patients who did and did not have diabetes. Significant differences between the diabetics versus nondiabetics included age (56 +/- 8 versus 49 +/- 1 years, P < .01), ischemic heart failure etiology (61% versus 44%, P = .04), history of hypertension (56% versus 30%, P < .01), thoracotomy (42% versus 30%, P = .08), stroke (14% versus 5%, P = .03), and body weight (86 +/- 16 kg versus 80 +/- 17 kg, P = .03), respectively. Eighty-four patients died on LVAD support, 28 of whom were diabetic. Thirty, 180, and 365-day survival for diabetic versus nondiabeticpatients was: 76.6%, 45.6%, and 30.4% for diabetics and 86.7%, 62.4%, and 47.1% for nondiabetics (P = .02 for 180 and 365-day morality). After controlling for other variables, patients with diabetes were at a higher risk of mortality (OR 1.76, 95%CI 1.05-2.94). No significant difference in survival was noted between insulin-dependent versus non-insulin-dependent diabetics. CONCLUSION:Patients with diabetes are at a higher risk of mortality after LVAD implantation.
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Authors: Aaron G Rizzieri; Joseph L Verheijde; Mohamed Y Rady; Joan L McGregor Journal: Philos Ethics Humanit Med Date: 2008-08-11 Impact factor: 2.464