Isabelle Johansson1, Ulf Dahlström2, Magnus Edner1, Per Näsman3, Lars Rydén1, Anna Norhammar1,4. 1. 1 Karolinska University Hospital Solna and Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden. 2. 2 Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden. 3. 3 Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden. 4. 4 Capio St. Göran's Hospital, Stockholm, Sweden.
Abstract
OBJECTIVE: To study the characteristics and prognostic implications of type 2 diabetes in different heart failure entities from a nationwide perspective. METHODS: This observational study comprised 30,696 heart failure patients prospectively included in the Swedish Heart Failure Registry (SwedeHF) 2003-2011 from specialist care, with mortality information available until December 2014. Patients were categorized into three heart failure entities by their left ventricular ejection fraction (heart failure with preserved ejection fraction: ⩾50%, heart failure with mid-range ejection fraction: 40%-49% and heart failure with reduced ejection fraction: <40%). All-cause mortality stratified by type 2 diabetes and heart failure entity was studied by Cox regression. RESULTS: Among the patients, 22% had heart failure with preserved ejection fraction, 21% had heart failure with mid-range ejection fraction and 57% had heart failure with reduced ejection fraction. The proportion of type 2 diabetes was similar, ≈25% in each heart failure entity. Patients with type 2 diabetes and heart failure with preserved ejection fraction were older, more often female and burdened with hypertension and renal impairment compared with heart failure with mid-range ejection fraction and heart failure with reduced ejection fraction patients among whom ischaemic heart disease was more common. Type 2 diabetes remained an independent mortality predictor across all heart failure entities after multivariable adjustment, somewhat stronger in heart failure with left ventricular ejection fraction below 50% (hazard ratio, 95% confidence interval; heart failure with preserved ejection fraction: 1.32 [1.22-1.43], heart failure with mid-range ejection fraction: 1.51 [1.39-1.65], heart failure with reduced ejection fraction: 1.46 [1.39-1.54]; p-value for interaction, p = 0.0049). CONCLUSION: Type 2 diabetes is an independent mortality predictor across all heart failure entities increasing mortality risk by 30%-50%. In type 2 diabetes, the heart failure with mid-range ejection fraction entity resembles heart failure with reduced ejection fraction in clinical characteristics, risk factor pattern and prognosis.
OBJECTIVE: To study the characteristics and prognostic implications of type 2 diabetes in different heart failure entities from a nationwide perspective. METHODS: This observational study comprised 30,696 heart failurepatients prospectively included in the Swedish Heart Failure Registry (SwedeHF) 2003-2011 from specialist care, with mortality information available until December 2014. Patients were categorized into three heart failure entities by their left ventricular ejection fraction (heart failure with preserved ejection fraction: ⩾50%, heart failure with mid-range ejection fraction: 40%-49% and heart failure with reduced ejection fraction: <40%). All-cause mortality stratified by type 2 diabetes and heart failure entity was studied by Cox regression. RESULTS: Among the patients, 22% had heart failure with preserved ejection fraction, 21% had heart failure with mid-range ejection fraction and 57% had heart failure with reduced ejection fraction. The proportion of type 2 diabetes was similar, ≈25% in each heart failure entity. Patients with type 2 diabetes and heart failure with preserved ejection fraction were older, more often female and burdened with hypertension and renal impairment compared with heart failure with mid-range ejection fraction and heart failure with reduced ejection fraction patients among whom ischaemic heart disease was more common. Type 2 diabetes remained an independent mortality predictor across all heart failure entities after multivariable adjustment, somewhat stronger in heart failure with left ventricular ejection fraction below 50% (hazard ratio, 95% confidence interval; heart failure with preserved ejection fraction: 1.32 [1.22-1.43], heart failure with mid-range ejection fraction: 1.51 [1.39-1.65], heart failure with reduced ejection fraction: 1.46 [1.39-1.54]; p-value for interaction, p = 0.0049). CONCLUSION:Type 2 diabetes is an independent mortality predictor across all heart failure entities increasing mortality risk by 30%-50%. In type 2 diabetes, the heart failure with mid-range ejection fraction entity resembles heart failure with reduced ejection fraction in clinical characteristics, risk factor pattern and prognosis.
Authors: Andrea Salzano; Roberta D'Assante; Eduardo Bossone; Alberto M Marra; Antonio Cittadini; Massimo Iacoviello; Vincenzo Triggiani; Giuseppe Rengo; Francesco Cacciatore; Ciro Maiello; Giuseppe Limongelli; Daniele Masarone; Angela Sciacqua; Pasquale Perrone Filardi; Antonio Mancini; Maurizio Volterrani; Olga Vriz; Roberto Castello; Andrea Passantino; Michela Campo; Pietro A Modesti; Alfredo De Giorgi; Michele Arcopinto; Paola Gargiulo; Maria Perticone; Annamaria Colao; Salvatore Milano; Agnese Garavaglia; Raffaele Napoli; Toru Suzuki Journal: Cardiovasc Diabetol Date: 2022-06-16 Impact factor: 8.949
Authors: Scott M Williams; Aikaterini Eleftheriadou; Uazman Alam; Daniel J Cuthbertson; John P H Wilding Journal: Diabetes Ther Date: 2019-09-24 Impact factor: 2.945