Are Women with Diabetes at Increased Risk of Repeated Heart Failure?

Heart failure is a common macrovascular complication that may occur in patients with diabetes, but what gender is more prone to have continuous hospitalization for repeated heart failure problems?

There has been scarce information that investigates the difference between the prognostic of diabetes in patients with heart failure. Since there have been few studies, the researchers believed that investigating this information would give them insight into new information. The purpose of this study was to examine if there was a gender modification in relationship with diabetes and chronic clinical outcomes in patients that were hospitalized for heart failure. 

In this study, researchers reviewed 3,162 records of patients who have been hospitalized for heart failure in the Korean Heart Failure registry. The researchers looked at records between June 2004 and April 2009, where they obtained the demographics and medical status of these patients. With this information, they found that 974 of the patients had been diagnosed with diabetes, while the other 2,188 patients didn’t have documentation of being diagnosed with diabetes. For patients with and without diabetes, the mean age was 68.7 and 66.9 years of age and about half of them were women, respectively.  Also, the document showed that most of the patients that were found to have diabetes were older. The confirmation of diabetes was determined with a hemoglobin A1c >6.5%, a random plasma blood glucose of >20mg/dL.(11.1 mmol/L), or fasting blood glucose of >126mg/dL.7 mmol/L. The primary outcome was a composite of all-cause mortality and readmission for heart failure.

Patients were followed for a median of 549 days. During this time, they discovered that 48.2% of the patients with diabetes experienced at least one of the primary outcomes, whereas 43.4% of the people without diabetes experienced at least one of the outcomes (P=0.013).  Also, they learned that most of the patients that were found to have diabetes were older and had more critical risk factors. The primary composite was 21% more likely to occur in patients with diabetes vs. patients without diabetes (HR = 1.21; 95% CI, 1.01-1.44). Women with diabetes were 43% more likely to experience the primary outcome compared to patients without diabetes (HR = 1.43; 95% CI, 1.12-1.84).  The number of men with diabetes was elevated but they weren’t statistically significant when compared to men without diabetes. 

The conclusion of this study stated that women with diabetes are at an increased likelihood of being readmitted to the hospital for heart failure and all-cause mortality.  Researchers have stated that female patients will need more monitoring and proper management if they have both heart failure and diabetes. Further studies should evaluate if race, gender, and age have played a part in diabetes and readmission rates for heart failure in patients. 

Practice Pearls:

• Patients that had both heart failure and diabetes were older and had more critical risk factors compared to those without diabetes.
• People with diabetes are more likely than people without diabetes to be readmitted for heart failure and increased risk of all-cause mortality.
• Women with diabetes are more likely to experience readmission for heart failure and all-cause mortality.

References for “Are Women with Diabetes at Increased Risk of Repeated Heart Failure?”:

Kim. “Repeat Heart Failure Risk Greater for Women with Diabetes.” Healio, www.healio.com/endocrinology/diabetes/news/online/{16ee3bf8-0dd6-4508-818c-ad7075915b5c}/repeat-heart-failure-risk-greater-for-women-with-diabetes?M_BT=2469436429117.

Kim, H.‐L., et al. “Gender Difference in the Impact of Coexisting Diabetes Mellitus on Long‐Term Clinical Outcome in People with Heart Failure: a Report from the Korean Heart Failure Registry – Kim – – Diabetic Medicine – Wiley Online Library.” Diabetic Medicine, John Wiley & Sons, Ltd (10.1111), 23 July 2019, onlinelibrary.wiley.com/doi/abs/10.1111/dme.14059.

Keri Hames, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences