On-treatment blood pressure and long-term outcomes in chronic kidney disease

2021 ◽  
Author(s):  
Hae Hyuk Jung
Keyword(s):  
Cardiovascular Events ◽  
Composite Outcome ◽  
Long Term Outcomes ◽  
Major Cardiovascular Events ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Composite Risk ◽  
Information Database

ABSTRACT Background The treatment BP target in CKD remains unclear, and whether the benefit of intensive BP-lowering is comparable between CKD and non-CKD patients is debated. Methods Using the Korean National Health Information Database, 359,492 CKD patients who had received antihypertensives regularly were identified from 12.1 million participants of nationwide health screening. The composite risk of major cardiovascular events, kidney failure, and all-cause mortality was assessed according to timely-averaged, on-treatment systolic BP. Results Over 9-year follow-up, the composite outcome noted in 18.4% of 239,700 participants with eGFR <60 ml/min/1.73 m2 and 18.9% of 155,004 with dipstick albuminuria. The thresholds of systolic BP, above which the composite risk increased significantly, in the reduced eGFR and the proteinuric population were 135 mm Hg and 125 mm Hg, respectively. For all-cause mortality, the respective thresholds were 145 mm Hg and 135 mm Hg. When comparing the composite risk between propensity score-matched groups, the hazard ratios of on-treatment BP of systolic 135–144 mm Hg (reference, 115–124 mm Hg) in the reduced eGFR and non-CKD pairs were 1.18 and 0.98, respectively (P = 0.13 for interaction), and those in the proteinuria and non-CKD pairs were 1.30 and 1.01, respectively (P = 0.003 for interaction). Conclusions The findings support the recommendation that, based on office BP, the systolic target in CKD with proteinuria is ≤ 130 mm Hg, and the target in CKD with no proteinuria is ≤ 140 mm Hg. The benefit of intensive BP-lowering may be greater in CKD patients particularly with proteinuria than in their non-CKD counterparts.

Long-term Mortality and Cardiovascular Events in Patients with Unilateral Primary Aldosteronism after Targeted Treatments

2021 ◽  
Author(s):  
Vin-Cent Wu ◽  
Shuo-Meng Wang ◽  
Kuo-How Huang ◽  
Yao-Chou Tsai ◽  
Chieh-Kai Chan ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Cardiovascular Events ◽  
Long Term Outcomes ◽  
Mineralocorticoid Receptor Antagonist ◽  
Major Cardiovascular Events ◽  
Targeted Treatments ◽  
All Cause Mortality ◽  
Long Term Mortality

OBJECTIVE: Long-term outcomes (especially mortality and/or major cardiovascular events [MACE]) of the unilateral primary aldosteronism (uPA) patients who underwent medical or surgery targeted treatment, relative to those with essential hypertension (EH), have been scarcely reported. DESIGN and SETTINGS: Using the prospectively designed observational TAIPAI cohort, we identified 858 uPA cases among 1220 primary aldosteronism (PA) patients and another 1210 EH controls. EXPOSURES Operated uPA patients were grouped via their 1-year post-therapy statuses. RESULTS PASO clinical complete success (hypertension-remission) was achieved in 272 (49.9%) of 545 surgically-treated uPA patients. After follow-up for 6.3±4.0 years, both hypertension-remissive (HR, 0.54, p< 0.001) and not-cured (HR, 0.61, p< 0.001) uPA patients showed a lower risk of all-cause mortality than that of EH controls; whereas the not-cured group had a higher risk of incident MACE (sub-hazard ratio (sHR), 1.41, p= 0.037) but similar atrial fibrillation (Af) and congestive heart failure (CHF). Mineralocorticoid receptor antagonist (MRA)-treated uPA patients had higher risks of MACE (sHR, 1.38, p= 0.033), Af (sHR,1.62, p= 0.049) and CHF (sHR, 1.44, p= 0.048) than those of EH controls, with mortality as a competing risk. Using inverse probability of treatment-weighted matching and counting adrenalectomy as a time-varying factor, treatment with adrenalectomy was associated with lower risks of all-cause mortality (HR 0.57; p= 0.035), MACE (HR 0.67; p= 0.037) and CHF (HR 0.49; p= 0.005) compared to those of MRA therapy. CONCLUSIONS : Adrenalectomy, independent of post-surgical hypertension remission, was associated with lower all-cause mortality of uPA patients, compared to that of EH patients. We further documented a more beneficial effect of adrenalectomy over MRA treatment on long-term mortality, MACE, and CHF in uPA patients.

Abstract 967: Parathyroidectomy Reduces Cardiovascular Events And All-cause Mortality In Renal Hyperparathyroidism

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jose Lima ◽  
Valeria Costa-Hong ◽  
Vanda Jorgetti ◽  
Luis Henrique W Gowdak ◽  
Rosa Maria A Moyses ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Mineral Metabolism ◽  
Cardiovascular Complications ◽  
Maintenance Hemodialysis ◽  
Major Cardiovascular Events ◽  
All Cause Mortality ◽  
Phosphate Product ◽  
Cardiovascular Variables ◽  
Overall Mortality

Background: Secondary hyperparathyroidism (SHPT) and its associated abnormalities in mineral metabolism increase the risk of cardiovascular morbidity and death in chronic kidney disease (CKD). The effect of parathyroidectomy (PTX) on the incidence of major cardiovascular events in CKD patients with SHPT is unknown. We tested the hypothesis that PTX reduces the incidence of cardiovascular complications and death in CKD patients with severe SHPT scheduled for PTX, comparing the outcome of patients treated or not treated by surgery. Methods: The study comprised 118 CKD patients with SHPT on maintenance hemodialysis, unresponsive to medical treatment, and scheduled for PTX. Patients underwent comprehensive cardiovascular evaluations at baseline. They were followed up until death, occurrence of major cardiovascular events, or kidney transplantation. Results: No deaths related to surgery occurred. After a median follow-up of 30 months, 50 patients (42.4%) had undergone PTX while 68 (57.9%) had not. The groups were comparable in terms of age, sex, race, parathyroid hormone (PTH), calcium, phosphate, calcium x phosphate product, and all major cardiovascular variables, except diastolic blood pressure. PTX was associated with a reduced incidence of major cardiovascular events (log-rank= 0.02) and overall mortality (log-rank= 0.001). Cox proportional multivariate analysis showed that variables significantly and independently associated with events were PTX (RR=2.36, CI 1.11–6.32, p=0.02) and age (RR=1.07, IC 1.02–1.14, p=0.009). All-cause mortality was related to PTX (RR=2.34, CI 1.25–5.14, p=0.007) and hematocrit (RR=1.15, CI 1.03–1.29, p=0.01). Conclusion: PTX confers protection against future major cardiovascular events and death in select CKD patients with severe refractory SHPT.

scholarly journals Cardiac Troponin T Predicts Long-Term Outcomes in Hemodialysis Patients

2001 ◽  
Vol 47 (3) ◽  
pp. 412-417 ◽  
Author(s):  
Daylily S Ooi ◽  
Deborah Zimmerman ◽  
Janet Graham ◽  
George A Wells
Keyword(s):  
Troponin I ◽  
Troponin T ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Peripheral Vascular ◽  
Long Term Outcomes ◽  
All Cause Mortality ◽  
End Stage

Abstract Background: Increased plasma troponin T (cTnT), but not troponin I (cTnI), is frequently observed in end-stage renal failure patients. Although generally considered spurious, we previously reported an associated increased mortality at 12 months. Methods: We studied long-term outcomes in 244 patients on chronic hemodialysis for up to 34 months, correlating the outcomes to plasma cTnT in routine predialysis samples. In addition, subsequent plasma samples at least 1 year later and within 6 months of data analysis were available in 97 patients and were used to identify patients with increasing plasma cTnT. The endpoints used were death and new or worsening coronary, cerebro-, and peripheral vascular disease and neuropathy. Results: Transplantation occurred more frequently in patients with low initial cTnT: 31%, 13%, and 3% in the groups with cTnT &lt;0.010, 0.010–0.099, and ≥0.100 μg/L, respectively. In the same groups, total deaths occurred in 6%, 43%, and 59% and cardiac deaths in 0%, 14%, and 24% of patients. In patients with follow-up samples, the group with increasing cTnT had a significantly increased death (relative risk, 2.0; P = 0.028). The increase was mainly in cardiac and sudden deaths. Conclusions: Higher plasma cTnT predicts long-term all-cause mortality in hemodialysis patients, even at concentrations &lt;0.100 μg/L, as does an increasing cTnT concentration over time.

P6448Major cardiovascular events free survival in the long term follow up of “real world” diabetic patients with stable coronary artery disease at the beginning of the 21st century. The CICCOR Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Ruiz Ortiz ◽  
J J Sanchez Fernandez ◽  
C Ogayar Luque ◽  
E Romo Penas ◽  
M Delgado Ortega ◽  
...  
Keyword(s):  
Real World ◽  
Cardiovascular Events ◽  
Stable Coronary Artery Disease ◽  
Diabetic Patients ◽  
Free Survival ◽  
End Point ◽  
Major Cardiovascular Events ◽  
Artery Disease

Abstract Background Safety trials of antidiabetic drugs have included a main endpoint of cardiovascular morbidity and mortality. However, “real world” data on long term prognosis of diabetic patients with stable coronary artery disease (sCAD) are limited. This study aimed to assess long-term incidence of major cardiovascular events in this population and to identify clinical predictors of this end-point. Methods The CICCOR registry is a prospective, monocentric, cohort study. From February 1, 2000 to January 31, 2004, all consecutive patients with sCAD attended at two outpatient cardiology clinics in a city of the south of Spain were included in the study and prospectively followed. Patients with type 2 diabetes mellitus were selected for this analysis. None of these patients received sodium-glucose cotransporter-2 inhibitors at first visit, as they were not commercially available at that time. Survival free of major cardiovascular events (combined end-point: acute myocardial infarction, stroke, or cardiovascular death) and variables associated with this end-point were investigated. Results The study sample included 394 patients (mean age 68±9 years, 61% male). After up to 17 years of follow-up (median 9 years, IQR 4–14 years, only 2 patients lost in follow-up, with a total of 3517 patients-years of observation), 66 had an acute myocardial infarction, 55 had an stroke and 165 died for cardiovascular causes. Survival free of major cardiovascular events was 88%, 70%, 57%, 47% and 32% at 3, 6, 9, 12 and 15 years. Multivariate predictors of the combined end-point are shown in the table. Predictors of major cardiovascular event Variable Hazard Ratio (95% CI) p value Age (year) 1.06 (1.04–1.08) <0.0005 Tobacco use 0.02 Never smoker 1 (reference) Ex-smoker 1.43 (1.02–1.99) 0.04 Active smoker 2.23 (1.16–4.30) 0.02 Functional Class ≥II (angina) 1.57 (1.14–2.16) 0.006 Resting heart rate (10 bpm increase) 1.12 (1.01–1.24) 0.04 Diuretic treatment at first visit 1.71 (1.26–2.30) 0.001 Conclusions Probability of major event-free survival was only 47% at 12 years in this “real world” cohort of diabetic patients with sCAD followed in the first 17 years of this century in a single center in the south of Spain. Simple clinical variables can identify patients at higher risk of events. Acknowledgement/Funding This work has been partially financed by an investigational grant by Boehringher Ingelheim

scholarly journals Impact of female sex in transcatheter aortic valve replacement. Long-term outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Gambo Ruberte ◽  
B Peiro Aventin ◽  
T Simon Paracuellos ◽  
D Gomez Martin ◽  
A Perez Guerrero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Long Term Outcomes ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Introduction Women comprise ≥50% patients undergoing transcatheter aortic valve replacement (TAVR). Women have different baseline clinical characteristics and some studies have suggested that TAVR procedure carries better results and prognosis. Purpose Evaluate gender differences in baseline characteristics and long-term outcomes in patients with aortic stenosis undergoing TAVR. Methods A cohort study was conducted. Consecutive patients underwent TAVR from January 2012 to December 2020 were included. Clinical and follow-up characteristics were recorded. MACE (major adverse cardiovascular events including all-cause mortality, myocardial infarction, cerebrovascular accident and heart failure hospitalization) as primary outcome was searched. Results A total of 292 consecutive patients were included. 48.95% were women and median age was 81.07 years (77.73–86.22). 77% TAVR patients received self-expanding prosthesis. Compared with men, women were significantly older and had lower glomerular filtration rate but a lower prevalence of comorbid conditions, such as atrial fibrillation (AF), coronary and peripheral arterial disease (PAD) and cerebrovascular disease. Left ventricular ejection fraction (LVEF) was higher in women. Global baseline characteristics and events at follow-up are summarized in figure 1. At a median follow up of 21.30 (8.52–38.94) months, MACE were lower in women (Odds ratio [OR] 0.60 95% CI: 0.36–1.00). Additionally, women showed lower rates of heart failure hospitalizations (OR 0.34 95% CI 0.16–0.70). There were no statistically significant differences in all-cause mortality. Survival curves for the endpoint of heart failure hospitalizations are represented in figure 2, showing a significant difference between men and women, and demonstrating that the latter present fewer events during follow-up (HR 0.42 95% CI 0.21–0.83). Conclusion In our study, female TAVR recipients had better outcomes than men. The possible reasons for this female-sex-related benefit could be due to better LVEF and fewer comorbidities. Understanding the reasons why men have worse prognostic post-TAVR is essential for guarantee appropriate treatment selection, as well as for achieving the best possible long-term and safety outcomes. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Use of sodium glucose cotransporter 2 inhibitors and risk of major cardiovascular events and heart failure: Scandinavian register based cohort study

BMJ ◽  
2019 ◽  
pp. l4772 ◽  
Author(s):  
Björn Pasternak ◽  
Peter Ueda ◽  
Björn Eliasson ◽  
Ann-Marie Svensson ◽  
Stefan Franzén ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Events ◽  
Sglt2 Inhibitor ◽  
Cardiovascular Death ◽  
Sglt2 Inhibitors ◽  
Major Cardiovascular Events ◽  
Hazard Ratios ◽  
History Of

Abstract Objective To investigate the cardiovascular effectiveness of sodium glucose cotransporter 2 (SGLT2) inhibitors in routine clinical practice. Design Cohort study using data from nationwide registers and an active-comparator new-user design. Setting Denmark, Norway, and Sweden, from April 2013 to December 2016. Participants 20 983 new users of SGLT2 inhibitors and 20 983 new users of dipeptidyl peptidase 4 (DPP4) inhibitors, aged 35-84, matched by age, sex, history of major cardiovascular disease, and propensity score. Main outcome measures Primary outcomes were major cardiovascular events (composite of myocardial infarction, stroke, and cardiovascular death) and heart failure (hospital admission for heart failure or death due to heart failure). Secondary outcomes were the individual components of the cardiovascular composite and any cause death. In the primary analyses, patients were defined as exposed from treatment start throughout follow-up (analogous to intention to treat); additional analyses were conducted with an as-treated exposure definition. Cox regression was used to estimate hazard ratios. Results Mean age of the study cohort was 61 years, 60% were men, and 19% had a history of major cardiovascular disease. Of the total 27 416 person years of follow-up in the SGLT2 inhibitor group, 22 627 (83%) was among patients who initiated dapagliflozin, 4521 (16%) among those who initiated empagliflozin, and 268 (1%) among those who initiated canagliflozin. During follow-up, 467 SGLT2 inhibitor users (incidence rate 17.0 events per 1000 person years) and 662 DPP4 inhibitor users (18.0) had a major cardiovascular event, whereas 130 (4.7) and 265 (7.1) had a heart failure event, respectively. Hazard ratios were 0.94 (95% confidence interval 0.84 to 1.06) for major cardiovascular events and 0.66 (0.53 to 0.81) for heart failure. Hazard ratios were consistent among subgroups of patients with and without history of major cardiovascular disease and with and without history of heart failure. Hazard ratios for secondary outcomes, comparing SGLT2 inhibitors with DPP4 inhibitors, were 0.99 (0.85 to 1.17) for myocardial infarction, 0.94 (0.77 to 1.15) for stroke, 0.84 (0.65 to 1.08) for cardiovascular death, and 0.80 (0.69 to 0.92) for any cause death. In the as-treated analyses, hazard ratios were 0.84 (0.72 to 0.98) for major cardiovascular events, 0.55 (0.42 to 0.73) for heart failure, 0.93 (0.76 to 1.14) for myocardial infarction, 0.83 (0.64 to 1.07) for stroke, 0.67 (0.49 to 0.93) for cardiovascular death, and 0.75 (0.61 to 0.91) for any cause death. Conclusions In this large Scandinavian cohort, SGLT2 inhibitor use compared with DPP4 inhibitor use was associated with reduced risk of heart failure and any cause death, but not with major cardiovascular events in the primary intention-to-treat analysis. In the additional as-treated analyses, the magnitude of the association with heart failure and any cause death became larger, and a reduced risk of major cardiovascular events that was largely driven by the cardiovascular death component was observed. These data help inform patients, practitioners, and authorities regarding the cardiovascular effectiveness of SGLT2 inhibitors in routine clinical practice.

Association of Blood Pressure with Cardiovascular Outcome and Mortality: Results from the KNOW-CKD Study

2021 ◽  
Author(s):  
Jee Young Lee ◽  
Jung Tak Park ◽  
Young Su Joo ◽  
Changhyun Lee ◽  
Hae-Ryong Yun ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Structural Models ◽  
Cardiovascular Outcome ◽  
Marginal Structural Models ◽  
Potential Hazard ◽  
Composite Outcome ◽  
Hazard Ratios ◽  
Adverse Cardiovascular Outcome ◽  
Primary Composite Outcome

Abstract Background Optimal BP control is a major therapeutic strategy to reduce adverse cardiovascular events and mortality in patients with CKD. We studied the association of BP with adverse cardiovascular outcome and all-cause death in patients with CKD. Methods Among 2,238 participants from the KoreaN cohort study for Outcome in patients With CKD, 2,226 patients with baseline BP measurements were enrolled. Main predictor was SBP categorized by 5 levels: &lt;110, 110-119, 120-129, 130-139, and ≥140 mmHg. Primary endpoint was a composite outcome of all-cause death or incident cardiovascular events. We primarily used marginal structural models using averaged and the most recent time-updated SBPs. Results During a median follow-up of 10233.79 person-years (median 4.60 years), the primary composite outcome occurred in 240 (10.8%) participants, with a corresponding incidence rate of 23.5 (95% CI, 20.7–26.6) per 1,000 patient-years. Marginal structural models with averaged SBP showed a U-shaped relationship with the primary outcome. Compared to time-updated SBP of 110–119 mmHg, hazard ratios (95% CI) for &lt;110, 120–129, 130–139, and ≥140 mmHg were 2.47 (1.48–4.11), 1.29 (0.80–2.08), 2.15 (1.26–3.69), and 2.19 (1.19–4.01), respectively. Marginal structural models with the most recent SBP also showed similar findings. Conclusions In Korean patients with CKD, there was a U-shaped association of SBP with the risk of adverse clinical outcome. Our findings highlight the importance of BP control and suggest a potential hazard of SBP &lt;110 mmHg.

scholarly journals Paclitaxel-coated Zilver PTX drug-eluting stent treatment does not result in increased long-term all-cause mortality compared to uncoated devices from Japan post-market surveillance study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Yokoi
Keyword(s):  
Real World ◽  
Drug Eluting Stent ◽  
Long Term Outcomes ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Post Market ◽  
Drug Eluting ◽  
Zilver Ptx

Abstract Purpose Favorable long-term outcomes with the Zilver PTX drug-eluting stent (DES) in treating patients with femoropopliteal lesions have been demonstrated. A multicenter, prospective, post-market surveillance study (PMS) in Japan evaluated this DES in a real-world patient population. Recently, meta-analysis that grouped both DES and drug-coated balloons (DCB) together indicated a higher incidence of late all-cause mortality for paclitaxel- based devices compared to uncoated balloon or bare-metal stent (BMS) at 2 years up to 5 years. To evaluate the long-term safety of the Zilver PTX DES, compared with BMS using Japan-PMS study. Methods The Japan DES PMS had no exclusion criteria and enrolled consecutive patients with symptomatic PAD involving the above-the-knee femoropopliteal arteries. Safety and effectiveness of the DES was evaluated in real-world patients with complex femoropopliteal artery lesions through 5 years. Follow-up in the study is complete. The concurrent Japan BMS PMS also had no exclusion criteria and enrolled consecutive patients with symptomatic PAD involving the above-the-knee femoropopliteal arteries. Patients who were enrolled in the BMS study but who also had a DES placed (n=18) were excluded from the current analysis. Follow-up in the BMS study was only required through 3 years and is complete. Results The Japan DES PMS enrolled 904 DES patients, and the Japan BMS PMS enrolled 190 BMS patients. In the DES group, there were 127 deaths through 3 years and 186deaths through 5 years. In the BMS group, there were 22 deaths through 3 years. Through 3 years, the risk of mortality was 15.7% for DES group and 15.3% for BMS group. Through 5 years, the risk of mortality was 25.8% for the DES group. There was no difference in mortality between the two groups (log-rank p=0.92).The Cox proportional hazards model revealed that CLI (p&lt;0.0001), age (p&lt;0.0001), gender (p=0.001), renal failure (p&lt;0.0001) were significantly associated with mortality. Hypercholesterolemia (p=0.004) was associated with lower risk of mortality. Treatment with Zilver PTX (p=0.49) was not associated with mortality. In the covariate analysis of paclitaxel dose, the significant factors were identical to the treatment analysis, and there was no association or trend of paclitaxel dose (p=0.07) with mortality. Conclusion Analyses of the paclitaxel-coated Zilver PTX DES utilizing patient-level data from the Japan PMS demonstrated no increase in long-term all-cause mortality. The 5-year results from this real-world, all-comers study continue to show positive long-term outcomes and demonstrate the benefit of the Zilver PTX DES across a broad patient population. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): COOK

scholarly journals Evaluation of “Sophia Diabetes”, a diabetic patient support programme, 8 years after its initiation

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
R Cash ◽  
M Cavillon ◽  
C Leboucher ◽  
B Jouaneton ◽  
A Vainchtock ◽  
...  
Keyword(s):  
Health Insurance ◽  
Disease Management ◽  
Cardiovascular Events ◽  
Positive Impact ◽  
Management Program ◽  
First Year ◽  
Patient Support ◽  
Major Cardiovascular Events

Abstract Background “Sophia Diabetes” is a personalized diabetic patient support program piloted by French National Health Insurance, launched experimentally in 10 primary health insurance funds in March 2008, extended in 2010 and then generalized to all of France in 2012-2013. A new evaluation was performed in 2018 to determine long-term (2008-2016) improvement of medical follow-up indicators, impact on morbidity, mortality and healthcare expenditure. Methods A sample of patients (n = 49,016) eligible for the programme in 2008, but also a sub-group of participating patients (n = 17,007), was matched, using propensity score, with controls randomly selected from the SNDS. Difference in difference method was applied for comparisons at each year of follow-up (Ti) while controlling for differences between populations. Results Sophia had a significant positive impact on recommended follow-up indicators, right from the first year. This improvement was maintained for most indicators even if compliance rates remained lower than targets. Sophia Diabetes does not appear to have a major impact on hospitalization rates in either eligible patients or participating patients. However, comparison between participants and controls revealed a less marked increase of hospitalizations for major cardiovascular events at T6 and T7. Compared to their controls, a better use of hospital emergency departments was observed for participants. Ambulatory care expenditure of participants increased more markedly between T4 and T7 (+€105 to €233), related to a better follow-up but in contrast, hospital expenditure increased less markedly during the first year of follow-up (-€139) and the last 2 years (-€360 to -€380). Conclusions For the first time in France, a disease management program has been evaluated over a long period. Globally, Sophia programresults in improved patient follow-up, decreased emergency visits, and a less marked increase of hospitalizations for major cardiovascular events at the end of period. Key messages First long term evaluation (8 years) of a disease management program in France. Sophia diabetes management program shows a positive impact on some follow-up and morbidity indicators.

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