Cardiovasc Diabetol. 2020;19(1):49.

Impact of diabetes mellitus on mortality in patients with acute heart failure: a prospective cohort study.

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제1저자 공민규, 장세용 · 교신저자 이해영

PMID 32359358 PMC7196232 DOI 10.1186/s12933-020-01026-3 IF 15.6 순환기내과

소속 (16)

Department of Internal Medicine, Soon Chun Hyang University Hospital, Bucheon, South Korea.
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Department of Biomedical Science, Seoul National University Graduate School, Seoul, South Korea.
Cancer Research Institute, Seoul National University, Seoul, South Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Department of Internal Medicine, Asan Medical Center, Seoul, South Korea.
Heart Research Center of Chonnam National University, Gwangju, South Korea.
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Catholic University of Korea, Seoul, South Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea. hylee612@snu.ac.kr.
Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. hylee612@snu.ac.kr.

Abstract

BACKGROUND Although more than one-third of the patients with acute heart failure (AHF) have diabetes mellitus (DM), it is unclear if DM has an adverse impact on clinical outcomes. This study compared the outcomes in patients hospitalized for AHF stratified by DM and left ventricular ejection fraction (LVEF).

METHODS The Korean Acute Heart Failure registry prospectively enrolled and followed 5625 patients from March 2011 to February 2019. The primary endpoints were in-hospital and overall all-cause mortality. We evaluated the impact of DM on these endpoints according to HF subtypes and glycemic control.

RESULTS During a median follow-up of 3.5 years, there were 235 (4.4%) in-hospital mortalities and 2500 (46.3%) overall mortalities. DM was significantly associated with increased overall mortality after adjusting for potential confounders (adjusted hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.03-1.22). In the subgroup analysis, DM was associated with higher a risk of overall mortality in heart failure with reduced ejection fraction (HFrEF) only (adjusted HR 1.14, 95% CI 1.02-1.27). Inadequate glycemic control (HbA1c ≥ 7.0% within 1 year after discharge) was significantly associated with a higher risk of overall mortality compared with adequate glycemic control (HbA1c < 7.0%) (44.0% vs. 36.8%, log-rank p = 0.016).

CONCLUSIONS DM is associated with a higher risk of overall mortality in AHF, especially HFrEF. Well-controlled diabetes (HbA1c < 7.0%) is associated with a lower risk of overall mortality compared to uncontrolled diabetes. Trial registration ClinicalTrial.gov, NCT01389843. Registered July 6, 2011. https://clinicaltrials.gov/ct2/show/NCT01389843.

Keywords

Acute heart failureDiabetes mellitusGlycemic controlLeft ventricular ejection fraction

Figures

**Fig. 1** Flow chart of the study. KorAHF registry, Korean Acute Heart Failure registry

**Fig. 2** Comparison of in-hospital and overall all-cause mortality as per DM status

**Fig. 3** Kaplan–Meier curves of all-cause mortality according to DM in subgroup by LVEF

**Fig. 4** Overall all-cause mortality as per the prespecified subgroup

**Fig. 5** Overall all-cause mortality as per glycemic control after discharge in patients with DM. *Well-controlled DM as an HbA1c < 7.0% at a follow-up visit within 1 year after discharge; Uncontrolled DM as an HbA1c ≥ 7.0%

그림 출처: PubMed Central 공개 논문 (PMC7196232)

Conflict of interest statement

The authors have no competing interests.

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