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

2020 ◽  
Author(s):  
Min Gyu Kong ◽  
Se Yong Jang ◽  
Jieun Jang ◽  
Hyun-Jai Cho ◽  
Sangjun Lee ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Glycemic Control ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Inadequate Glycemic Control ◽  
Long Term Mortality

Abstract Background Although more than one third of the patients with acute heart failure (AHF) have diabetes mellitus (DM), it is unclear whether DM exerts adverse impact on clinical outcomes. This study aimed to compare the outcomes in patients hospitalized for AHF in accordance with DM and left ventricular ejection fraction (LVEF). Methods The Korean Acute Heart Failure registry prospectively enrolled and completed follow-up of 5,625 patients from March 2011 to February 2019. Primary endpoints were in-hospital and overall all-cause mortality. We evaluated the impact of DM on these mortalities according to HF subtypes and glycemic control. Results DM was significantly associated with increased long-term mortality (adjusted hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.02-1.22) even after adjusting for potential confounders. In subgroup analysis according to LVEF, DM was associated with higher long-term mortality in only HF with reduced ejection fraction (HFrEF) (adjusted HR, 1.14; 95% CI, 1.02-1.27). Inadequate glycemic control defined by HbA1c ≥ 7.0% within 1 year after discharge was significantly associated with higher long-term mortality compared to adequate glycemic control (HbA1c <7.0%) (44.0% vs. 36.8%; Log-rank p =0.016). Conclusions This large registry data showed that DM and inadequate glycemic control were significantly associated with increased long-term mortality in AHF, especially HFrEF. Tight glucose control is required to mitigate long-term mortality.

scholarly journals Impact of Diabetes Mellitus on Mortality in Patients with Acute Heart Failure: A Prospective Cohort Study

2020 ◽  
Author(s):  
Min Gyu Kong ◽  
Se Yong Jang ◽  
Jieun Jang ◽  
Hyun-Jai Cho ◽  
Sangjun Lee ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Glycemic Control ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
The Impact ◽  
Overall Mortality

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 5,625 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 2,500 (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

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

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.

Effect of Sacubitril/Valsartan Combined with Dapagliflozin on Long-Term Cardiac Mortality in Heart Failure with Reduced Ejection Fraction

Angiology ◽  
2021 ◽  
pp. 000331972110473
Author(s):  
Umut Karabulut ◽  
Kudret Keskin ◽  
Dilay Karabulut ◽  
Ece Yiğit ◽  
Zerrin Yiğit
Keyword(s):  
Heart Failure ◽  
Combination Therapy ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Mortality ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor

The angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan and sodium-glucose cotransporter-2 (SGLT-2) inhibitor dapagliflozin have been shown to reduce rehospitalization and cardiac mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to compare the long-term cardiac and all-cause mortality of ARNI and dapagliflozin combination therapy against ARNI monotherapy in patients with HFrEF. This retrospective study involved 244 patients with HF with New York Heart Association (NYHA) class II–IV symptoms and ejection fraction ≤40%. The patients were divided into 2 groups: ARNI monotherapy and ARNI+dapagliflozin. Median follow-up was 2.5 (.16–3.72) years. One hundred and seventy-five (71.7%) patients were male, and the mean age was 65.9 (SD, 10.2) years. Long-term cardiac mortality rates were significantly lower in the ARNI+dapagliflozin group (7.4%) than in the ARNI monotherapy group (19.5%) ( P = .01). Dapagliflozin [Hazard Ratio (HR) [95% Confidence Interval (CI)] = .29 [.10–.77]; P = .014] and left ventricular ejection fraction (LVEF) [HR (95% CI) = .89 (.85–.93); P < .001] were found to be independent predictors of cardiac mortality. Our study showed a significant reduction in cardiac mortality with ARNI and dapagliflozin combination therapy compared with ARNI monotherapy.

scholarly journals NT-proBNP and Echocardiographic Parameters in Patients with Acute Heart Failure

2007 ◽  
Vol 50 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Radek Pudil ◽  
Miloš Tichý ◽  
Rudolf Praus ◽  
Václav Bláha ◽  
Jan Vojáček
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Vena Cava ◽  
Left Ventricular ◽  
Clinical Severity ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
X Ray ◽  
Cardiothoracic Ratio

Aim. The aim of this study was to analyse the relation between clinical, haemodynamic and X-ray parameters and plasma NT-proBNP level in pts with symptoms of left ventricular dysfunction. Methods. The plasma NT-proBNP levels, chest x-ray, transthoracic 2-d and Doppler echocardiography were performed at the time of admission in a group of 96 consecutive patients (mean age 68 ± 11 years) with symptoms of acute heart failure. NT-proBNP levels were assessed with the use of commercial tests (Roche Diagnostics). Results. All patients have significant increase in NT-proBNP (8 000 ± 9 000 pg/mL vs. controls 90 ± 80 pg/mL, p < 0.001). The group of all patients has shown a significant increase in cardiothoracic ratio (CTR, 0.6 ± 0.1, vs. 0.4 ± 0.1, p <0.001), left atrium diameter (LAD, 4.4 ± 0.8 cm, vs.3.5 ± 0.4 cm, p <0.01). Left ventricular ejection fraction (LVEF) was decreased (37 ± 15%, vs. 64 ± 5%, p <0.001). In patients with acute heart failure, NT-proBNP significantly correlated with end-systolic and end-diastolic left ventricle diameters, ejection fraction, vena cava inferior diameter and plasma creatinine levels. Conclusion. Increased plasma NT-proBNP level is influenced by the clinical severity of acute heart failure and correlates with LVEF and IVCD. NT-proBNP can serve as a marker for the clinical severity of the disease.

Sign in / Sign up

Export Citation Format

Share Document