Article Text
Abstract
Background: Poor prognosis in heart failure (HF) patients with diabetes is often attributed to increased comorbidity and advanced disease. Further, this effect may be worse in women.
Objective: To determine whether the effect of diabetes on outcomes and the sex-related variation persisted in a propensity score matched HF population, and whether the sex-related variation was a function of age.
Methods: Of the 7788 HF patients in the Digitalis Investigation Group trial, 2218 had a history of diabetes. Propensity score for diabetes was calculated for each patient using a non-parsimonious logistic regression model incorporating all measured baseline covariates, and was used to match 2056 (93%) diabetic patients with 2056 non-diabetic patients.
Results: All-cause mortality occurred in 135 (25%) and 216 (39%) women without and with diabetes (adjusted hazard ratio {AHR} =1.67; 95% confidence interval {CI} =1.34-2.08; p<0.0001). Among men, 535 (36%) and 609 (41%) patients without and with diabetes died from all causes (AHR =1.21; 95% CI =1.07-1.36; p=0.002). Sex-diabetes interaction (overall adjusted p <0.0001) was only significant in patients >65 years (15% absolute risk increase in women; multivariable p for interaction =0.005), but not in younger patients (2% increase in women; p for interaction =0.173). Risk-adjusted HR (95% CI) for all-cause hospitalization for women and men were respectively 1.49 (1.28-1.72) and 1.21 (1.11-1.32), also with significant sex-diabetes interaction (p=0.011).
Conclusions: Diabetes-associated increases in morbidity and mortality in chronic HF were more pronounced in women, and theses sex-related differences in outcomes were primarily observed in elderly patients.
- Age
- Diabetes
- Heart failure
- Outcomes
- Sex
Statistics from Altmetric.com
Request Permissions
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.