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.