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Prognostic impact of diabetes mellitus in patients with heart failure and preserved ejection fraction. A prospective 5-year study
  1. Christophe Tribouilloy (tribouilloy.christophe{at}chu-amiens.fr)
  1. INSERM, ERI 12, Amiens, France and University Hospital, Amiens, France
    1. Dan Rusinaru (drusinaru2003{at}yahoo.com)
    1. INSERM, ERI 12, Amiens, France and University Hospital Amiens, France
      1. Haïfa Mahjoub
      1. INSERM, ERI 12, Amiens, France and University Hospital Amiens, France
        1. Jean-Michel Tartiere
        1. Department of Physiology, Lariboisière Hospital, AP-HP, Paris, France
          1. Lamia Kesri-Tartiere
          1. Department of Cardiology, Bichat Claude Bernard Hospital, AP-HP, Paris, France
            1. Stephanie Godard
            1. INSERM, ERI 12, Amiens, France and University Hospital Amiens, France
              1. Marcel Peltier
              1. INSERM, ERI 12, Amiens,France and University Hospital Amiens, France

                Abstract

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

                Design A 5-year prospective observational study

                Setting Population of 386 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 ACE-inhibitors, calcium channel blockers, nitrates and statins. During the 5-year follow-up, 208 patients died (43.5%). DM was a potent independent predictor of 5-year overall mortality (HR 1.77, 95%CI 1.27-2.48, p=0.001). Compared to the expected survival of the age- and gender-matched general population, the 5-year survival of patients with DM was dramatically lower (32% vs. 79%). The 5-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 1.02-3.25, p=0.04), as well as in patients without clinical CAD (HR 1.85, 95%CI 1.22-2.82, p=0.004).

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

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