OBJECTIVE: Diabetes increases mortality in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction. Studies have questioned the safety of β-adrenoceptor blockers (β-blockers) in some patients with diabetes and reduced left ventricular ejection fraction. We examined whether β-blockers and ACE inhibitors (ACEIs) are associated with differential effects on mortality in CHF patients with and without diabetes. RESEARCH DESIGN AND METHODS: We conducted a prospective cohort study of 1,797 patients with CHF recruited between 2006 and 2014, with mean follow-up of 4 years. β-Blocker dose was expressed as the equivalent dose of bisoprolol (mg/day) and ACEI dose as the equivalent dose of ramipril (mg/day). Cox regression analysis was used to examine the interaction between diabetes and drug dose on all-cause mortality. RESULTS: Patients with diabetes were prescribed larger doses of β-blockers and ACEIs than were patients without diabetes. Increasing β-blocker dose was associated with lower mortality in patients with diabetes (8.9% per mg/day; 95% CI 5-12.6) and without diabetes (3.5% per mg/day; 95% CI 0.7-6.3), although the effect was larger in people with diabetes (interaction P = 0.027). Increasing ACEI dose was associated with lower mortality in patients with diabetes (5.9% per mg/day; 95% CI 2.5-9.2) and without diabetes (5.1% per mg/day; 95% CI 2.6-7.6), with similar effect size in these groups (interaction P = 0.76). CONCLUSIONS: Increasing β-blocker dose is associated with a greater prognostic advantage in CHF patients with diabetes than in CHF patients without diabetes.
OBJECTIVE:Diabetes increases mortality in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction. Studies have questioned the safety of β-adrenoceptor blockers (β-blockers) in some patients with diabetes and reduced left ventricular ejection fraction. We examined whether β-blockers and ACE inhibitors (ACEIs) are associated with differential effects on mortality in CHFpatients with and without diabetes. RESEARCH DESIGN AND METHODS: We conducted a prospective cohort study of 1,797 patients with CHF recruited between 2006 and 2014, with mean follow-up of 4 years. β-Blocker dose was expressed as the equivalent dose of bisoprolol (mg/day) and ACEI dose as the equivalent dose of ramipril (mg/day). Cox regression analysis was used to examine the interaction between diabetes and drug dose on all-cause mortality. RESULTS:Patients with diabetes were prescribed larger doses of β-blockers and ACEIs than were patients without diabetes. Increasing β-blocker dose was associated with lower mortality in patients with diabetes (8.9% per mg/day; 95% CI 5-12.6) and without diabetes (3.5% per mg/day; 95% CI 0.7-6.3), although the effect was larger in people with diabetes (interaction P = 0.027). Increasing ACEI dose was associated with lower mortality in patients with diabetes (5.9% per mg/day; 95% CI 2.5-9.2) and without diabetes (5.1% per mg/day; 95% CI 2.6-7.6), with similar effect size in these groups (interaction P = 0.76). CONCLUSIONS: Increasing β-blocker dose is associated with a greater prognostic advantage in CHFpatients with diabetes than in CHFpatients without diabetes.
Authors: John Gierula; Richard M Cubbon; Maria F Paton; Rowenna Byrom; Judith E Lowry; Sarah F Winsor; Melanie McGinlay; Emma Sunley; Emma Pickles; Lorraine C Kearney; Aaron Koshy; Thomas A Slater; Hemant K Chumun; Haqeel A Jamil; Kristian M Bailey; Julian H Barth; Mark T Kearney; Klaus K Witte Journal: Eur Heart J Qual Care Clin Outcomes Date: 2019-07-01
Authors: Ina Nemet; Prasenjit Prasad Saha; Nilaksh Gupta; Weifei Zhu; Kymberleigh A Romano; Sarah M Skye; Tomas Cajka; Maradumane L Mohan; Lin Li; Yuping Wu; Masanori Funabashi; Amanda E Ramer-Tait; Sathyamangla Venkata Naga Prasad; Oliver Fiehn; Federico E Rey; W H Wilson Tang; Michael A Fischbach; Joseph A DiDonato; Stanley L Hazen Journal: Cell Date: 2020-03-05 Impact factor: 41.582
Authors: Ben N Mercer; Aaron Koshy; Michael Drozd; Andrew M N Walker; Peysh A Patel; Lorraine Kearney; John Gierula; Maria F Paton; Judith E Lowry; Mark T Kearney; Richard M Cubbon; Klaus K Witte Journal: J Am Heart Assoc Date: 2018-10-16 Impact factor: 5.501
Authors: Andrew M N Walker; Michael Drozd; Marlous Hall; Peysh A Patel; Maria Paton; Judith Lowry; John Gierula; Rowenna Byrom; Lorraine Kearney; Robert J Sapsford; Klaus K Witte; Mark T Kearney; Richard M Cubbon Journal: J Am Heart Assoc Date: 2018-10-16 Impact factor: 5.501
Authors: Aaron O Koshy; Elisha R Gallivan; Melanie McGinlay; Sam Straw; Michael Drozd; Anet G Toms; John Gierula; Richard M Cubbon; Mark T Kearney; Klaus K Witte Journal: ESC Heart Fail Date: 2020-08-05