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Diabetes Mellitus a Prognosis in CHF

DM associated with increased risk of death in congestive heart failure (CHF) patients….

It is believed that diabetes mellitus is an adverse prognostic factor in patients with chronic heart failure. It also has an impact on the cardiovascular mortality in ischaemic and non-ischaemic cardiomyopathies. Many studies have shown a prevalence of at least 25% in CHF with reduced left ventricular ejection fraction.

In this cohort study, 1091 unselected patients with CHF who were treated with ‘state-of-the-art’ therapies were examined. Patients had to be ambulant outpatients with stable signs and symptoms of CHF for 3 months and a LV ejection fraction of ≤45%.

Of the 1091 patients, 25.7% presented with diabetes. These patients had a mean HbA1c of 7.8%. Diabetes Mellitus was associated with significantly greater crude hazard ratios for all-cause and cardiovascular mortality. DM was also observed to have significantly increased HRs for progressive HF and sudden cardiovascular mortality.

Patients with DM were found to be significantly greater in the ischaemic than the non-ischaemic group (29.6% vs. 15.2%). There were no differences in demographics or treatment factors between these groups. The authors concluded that DM is associated with an increased risk of death in patients with ischaemic and non-ischaemic CHF. Limitations of the study include the fact that DM was based on previous diagnosis and routine screening of patients were not done. This may have an impact on the true effect of DM in the analyses. Another limitation was that ischaemic cardiomyopathy was based on a physician’s discretion and not via invasive coronary angiography.

Practice Pearls:
  • DM shows increased progression of heart failure.
  • DM associated with cardiovascular mortality.
  • Even with medication therapy and device-based therapy, diabetes continues to increase the risk of death.

Diabetes & Vascular Disease Research Oct. 2013