Acute heart failure in patients with diabetes mellitus: Clinical characteristics and predictors of in-hospital mortality

Acute Heart Failure (AHF)-related hospitalizations and mortality are still high in western countries, especially among older patients. This study aimed to describe the clinical characteristics and predictors of in-hospital mortality of older patients hospitalized with AHF. We conducted a retrospective study including all consecutive patients ≥65 years who were admitted for AHF at a single academic medical center between 1 January 2008 and 31 December 2018. The primary outcome was all-cause, in-hospital mortality. We also analyzed deaths due to cardiovascular (CV) and non-CV causes and compared early in-hospital events. The study included 6930 patients, mean age 81 years, 51% females. The overall mortality rate was 13%. Patients ≥85 years had higher mortality and early death rate than younger patients. Infections were the most common condition precipitating AHF in our cohort, and pneumonia was the most frequent of these. About half of all hospital deaths were due to non-CV causes. After adjusting for confounding factors other than NYHA class at admission, infections were associated with an almost two-fold increased risk of mortality, HR 1.74, 95% CI 1.10–2.71 in patients 65–74 years (p = 0.014); HR 1.83, 95% CI 1.34–2.49 in patients 75–84 years (p = 0.001); HR 1.74, 95% CI 1.24–2.19 in patients ≥85 years (p = 0.001). In conclusion, among older patients with AHF, in-hospital mortality rates increased with increasing age, and infections were associated with an increased risk of in-hospital mortality. In contemporary patients with AHF, along with the treatment of the CV conditions, management should be focused on timely diagnosis and appropriate treatment of non-CV factors, especially pulmonary infections.

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Clinical Characteristics and Predictors of In-Hospital Mortality in Acute Heart Failure With Preserved Left Ventricular Ejection Fraction

The American Journal of Cardiology ◽

10.1016/j.amjcard.2010.08.044 ◽

2011 ◽

Vol 107 (1) ◽

pp. 79-84 ◽

Cited By ~ 30

Author(s):

John T. Parissis ◽

Ignatios Ikonomidis ◽

Pinelopi Rafouli-Stergiou ◽

Alexandre Mebazaa ◽

Juan Delgado ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Clinical Characteristics ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

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Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus

Cardiovascular Diabetology ◽

10.1186/s12933-021-01370-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Se Yong Jang ◽

Jieun Jang ◽

Dong Heon Yang ◽

Hyun-Jai Cho ◽

Soo Lim ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Glycemic Control ◽

Insulin Therapy ◽

Acute Heart Failure ◽

Mortality Risk ◽

Left Ventricular ◽

Hypoglycemic Agents ◽

Left Ventricular Ejection ◽

Patients With Diabetes

Abstract Background Patients with diabetes mellitus (DM) have a higher prevalence of heart failure (HF) than those without it. Approximately 40 % of HF patients have DM and they tend to have poorer outcomes than those without DM. This study evaluated the impact of insulin therapy on mortality among acute HF patients. Methods A total of 1740 patients from the Korean Acute Heart Failure registry with DM were included in this study. The risk of all-cause mortality according to insulin therapy was assessed using the Cox proportional hazard models with inverse probability of treatment weighting to balance the clinical characteristics (pretreatment covariates) between the groups. Results DM patients had been treated with either oral hypoglycemic agents (OHAs) alone (n = 620), insulin alone (n = 682), or insulin combined with OHAs (n = 438). The insulin alone group was associated with an increased mortality risk compared with the OHA alone group (HR = 1.41, 95 % CI 1.21–1.66]). Insulin therapy combined with OHAs also showed an increased mortality risk (HR = 1.29, 95 % CI 1.14–1.46) compared with the OHA alone group. Insulin therapy was consistently associated with increased mortality risk, regardless of the left ventricular ejection fraction (LVEF) or HF etiology. A significant increase in mortality was observed in patients with good glycemic control (HbA1c < 7.0 %) receiving insulin, whereas there was no significant association in patients with poor glycemic control (HbA1c ≥ 7.0%). Conclusions Insulin therapy was found to be associated with increased mortality compared to OHAs. The insulin therapy was harmful especially in patients with low HbA1c levels which may suggest the necessity of specific management strategies and blood sugar targets when using insulin in patients with HF.

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In-Hospital Outcome Of Acute Coronary Syndrome In Patients With Diabetes Mellitus

University Heart Journal ◽

10.3329/uhj.v5i1.3437 ◽

2009 ◽

Vol 5 (1) ◽

pp. 24-27

Author(s):

Dilip Kumar Sarker ◽

KMHS Sirajul Haque ◽

Md Abu Siddique ◽

Md Khurshed Ahmed ◽

Fazlur Rahman ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Congestive Heart Failure ◽

Acute Coronary Syndrome ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Diabetic Patients ◽

Coronary Syndrome ◽

Recurrent Angina ◽

Patients With Diabetes

Diabetes mellitus adversely influences the outcome of acute coronary syndrome. This study evaluated the in-hospital outcome of acute coronary syndrome in patients with diabetes mellitus. In this prospective observation study 130 patients with acute coronary syndrome were enrolled. They were divided into diabetic and nondiabetic group. Diabetic patients were taken as case and nondiabetic patients as control. Outcome parameter studied were in-hospital mortality, cardiogenic shock, congestive heart failure, different arrhythmias and recurrent angina. In this study, one third (32%) of the patients were diabetic with mean age 58±10.0 years vs. 53.0±13.6 years in diabetic and nondiabetic group, respectively. Majority of the patients in both groups were male. Congestive heart failure and arrhythmias were more common in case group compared to those in control group (19% vs. 13.6% p=0.424; 23.8% vs. 13.6%, p= 0.148, respectively). Cardiogenic shock developed in 7.1% of diabetic patients and 8% of nondiabetic patients. In hospital mortality was 7.1% and 5.7% in diabetic and nondiabetic group, respectively. Recurrent angina developed only in diabetic patients. Therefore, diabetic patients with acute coronary syndrome encountered more in- hospital adverse outcome. doi: 10.3329/uhj.v5i1.3437 University Heart Journal Vol. 5, No. 1, January 2009 24-27

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488 In hospital mortality after admission for acute heart failure is two fold higher in patients older than 80 years. Insights from the Italian AHF registry

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(07)60297-5 ◽

2007 ◽

Vol 6 (1) ◽

pp. 107-107

Author(s):

D MIANI ◽

C FRESCO ◽

D LUCCI ◽

M ALBANESE ◽

L MAINARDI ◽

...

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Acute Heart Failure

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Care Pathways of Acute Heart Failure Patients: Impact on In-hospital Mortality.

Case Medical Research ◽

10.31525/ct1-nct03903198 ◽

2019 ◽

Author(s):

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Care Pathways ◽

Heart Failure Patients

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Is oxygen therapy beneficial for normoxemic patients with acute heart failure? A propensity score matched study

Military Medical Research ◽

10.1186/s40779-021-00330-7 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Yue Yu ◽

Ren-Qi Yao ◽

Yu-Feng Zhang ◽

Su-Yu Wang ◽

Wang Xi ◽

...

Keyword(s):

Heart Failure ◽

Linear Regression ◽

Propensity Score ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Oxygen Therapy ◽

Ambient Air ◽

Supplemental Oxygen ◽

Research Database ◽

Icu Mortality

Abstract Background The clinical efficiency of routine oxygen therapy is uncertain in patients with acute heart failure (AHF) who do not have hypoxemia. The aim of this study was to investigate the association between oxygen therapy and clinical outcomes in normoxemic patients hospitalized with AHF using real-world data. Methods Normoxemic patients diagnosed with AHF on ICU admission from the electronic ICU (eICU) Collaborative Research Database were included in the current study, in which the study population was divided into the oxygen therapy group and the ambient-air group. Propensity score matching (PSM) was applied to create a balanced covariate distribution between patients receiving supplemental oxygen and those exposed to ambient air. Linear regression and logistic regression models were performed to assess the associations between oxygen therapy and length of stay (LOS), and all-cause in-hospital as well as ICU mortality rates, respectively. A series of sensitivity and subgroup analyses were conducted to further validate the robustness of our findings. Results A total of 2922 normoxemic patients with AHF were finally included in the analysis. Overall, 42.1% (1230/2922) patients were exposed to oxygen therapy, and 57.9% (1692/2922) patients did not receive oxygen therapy (defined as the ambient-air group). After PSM analysis, 1122 pairs of patients were matched: each patient receiving oxygen therapy was matched with a patient without receiving supplemental oxygen. The multivariable logistic model showed that there was no significant interaction between the ambient air and oxygen group for all-cause in-hospital mortality [odds ratio (OR) 1.30; 95% confidence interval (CI) 0.92–1.82; P = 0.138] or ICU mortality (OR 1.39; 95% CI 0.83–2.32; P = 0.206) in the post-PSM cohorts. In addition, linear regression analysis revealed that oxygen therapy was associated with prolonged ICU LOS (OR 1.11; 95% CI 1.06–1.15; P < 0.001) and hospital LOS (OR 1.06; 95% CI 1.01–1.10; P = 0.009) after PSM. Furthermore, the absence of an effect of supplemental oxygen on mortality was consistent in all subgroups. Conclusion Routine use of supplemental oxygen in AHF patients without hypoxemia was not found to reduce all-cause in-hospital mortality or ICU mortality.

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Determinants of In-Hospital Mortality in Elderly Patients Aged 80 Years or above with Acute Heart Failure: A Retrospective Cohort Study at a Single Rural Hospital

Journal of Clinical Medicine ◽

10.3390/jcm10071468 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1468

Author(s):

Yusuke Watanabe ◽

Kazuko Tajiri ◽

Hiroyuki Nagata ◽

Masayuki Kojima

Keyword(s):

Heart Failure ◽

Regression Analysis ◽

Elderly Patients ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Stepwise Regression ◽

Stepwise Regression Analysis ◽

Antibiotic Administration ◽

Very Elderly ◽

Survivor Group

Heart failure is one of the leading causes of mortality worldwide. Several predictive risk scores and factors associated with in-hospital mortality have been reported for acute heart failure. However, only a few studies have examined the predictors in elderly patients. This study investigated determinants of in-hospital mortality in elderly patients with acute heart failure, aged 80 years or above, by evaluating the serum sodium, blood urea nitrogen, age and serum albumin, systolic blood pressure and natriuretic peptide levels (SOB-ASAP) score. We reviewed the medical records of 106 consecutive patients retrospectively and classified them into the survivor group (n = 83) and the non-survivor group (n = 23) based on the in-hospital mortality. Patient characteristics at admission and during hospitalization were compared between the two groups. Multivariate stepwise regression analysis was used to evaluate the in-hospital mortality. The SOB-ASAP score was significantly better in the survivor group than in the non-survivor group. Multivariate stepwise regression analysis revealed that a poor SOB-ASAP score, oral phosphodiesterase 3 inhibitor use, and requirement of early intravenous antibiotic administration were associated with in-hospital mortality in very elderly patients with acute heart failure. Severe clinical status might predict outcomes in very elderly patients.

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