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Heart failure and cardiomyopathy
Prognostic impact of diabetes mellitus in patients with heart failure and preserved ejection fraction: a prospective five-year study
  1. C Tribouilloy1,
  2. D Rusinaru1,
  3. H Mahjoub1,
  4. J-M Tartière2,
  5. L Kesri-Tartière3,
  6. S Godard1,
  7. M Peltier1
  1. 1
    INSERM, ERI 12, Amiens, and University Hospital Amiens, France
  2. 2
    Department of Physiology, Lariboisière Hospital, Paris, France
  3. 3
    Department of Cardiology, Bichat Claude Bernard Hospital, Paris, France
  1. Professor Christophe Tribouilloy, Department of Cardiology, Avenue René Laënnec, 80054 Amiens Cedex 1, France; tribouilloy.christophe{at}chu-amiens.fr

Abstract

Objective: To evaluate the prognostic impact of diabetes mellitus (DM) in patients with heart failure and preserved ejection fraction (HFPEF)

Design: A five-year prospective observational study

Setting: Population of 368 consecutive patients from 11 healthcare establishments

Patients: All patients hospitalised for a first episode of HFPEF in 2000 in the Somme department, France.

Interventions: Diagnosis of heart failure (HF) was validated during the index hospitalisation by two independent cardiologists. Diabetic and non-diabetic groups were compared. After discharge, patients were managed by the general practitioner or referring cardiologist.

Main outcome measures: Overall and cardiovascular mortality.

Results: The 96 diabetic patients (26%) were younger and had a higher prevalence of clinical coronary artery disease (CAD) than non-diabetic patients. Patients with DM had higher discharge prescription rates of angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, nitrates and statins. During the five-year follow-up, 208 patients died (43.5%). DM was a potent independent predictor of five-year overall mortality (HR 1.77, 95% CI 1.27 to 2.48, p = 0.001). Compared to the expected survival of the age-matched and gender-matched general population, the five-year survival of patients with DM was dramatically lower (32% vs 79%). The five-year relative survival (observed/expected survival) of diabetic patients was lower than that of the non-diabetic group (41% vs 68%). Cardiovascular causes were responsible for >60% of deaths in the DM group. DM was associated with an increased risk of death in patients with clinical CAD (HR 1.82, 95% CI 1.02 to 3.25, p = 0.04), as well as in patients without clinical CAD (HR 1.85, 95% CI 1.22 to 2.82, p = 0.004).

Conclusion: In patients with HFPEF, DM is a strong predictor of poorer long-term survival.

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Footnotes

  • Competing interests: None.

  • Funding: This study was funded by a grant from the French Ministry of Health.

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