Mortality and Cardiovascular Complications in Older Complex Chronic Patients with Type 2 Diabetes

Aims/Introduction. Determining the prevalence of diabetes and its cardiovascular complications and all-cause mortality in older chronic complex patients. Materials and Methods. We carried out a multicenter retrospective study and included a randomized sample of 932 CCP people. We assessed the prevalence of diabetes according to World Health Organization criteria. Data included demographics and functional, comorbidity, cognitive, and social assessment. Results. The prevalence of diabetes was 53% and average age 81.16±8.93 years. There were no significant differences in the survival of CCP patients with or without DM, with or without ischaemic cardiopathy, and with or without peripheral vascular disease. The prognostic factors of all-cause mortality in patients with DM were age ≥ 80 years [HR 1.47, 95% CI 1.02–2.13, p 0.038], presence of heart failure [HR 1.73, 95% CI 1.25–2.38, p 0.001], Charlson score [HR 1.20, 95% CI 1.06–1.36, p 0.003], presence of cognitive impairment [HR 1.73, 95% CI 1.24–2.40, p 0.001], and no treatment with statins [HR 1.49, 95% CI 1.08–2.04, p 0.038]. Conclusions. We found high prevalence of DM among CCP patients and the relative importance of traditional risk factors seemed to wane with advancing age. Recommendations may include relaxing treatment goals, providing family/patient education, and enhanced communication strategies.

Clinical Implications of Anemia in Heart Failure (HF) Patients (pts).

Previous studies have shown that anemia is frequently associated with higher morbidity and mortality in HF pts. Our aim was to determine the impact of anemia in pts hospitalized with congestive HF at our hospital. We analyzed data from 277 pts with diagnosis of HF admitted between 1 June 2004 and 31 December 2005, with a follow up of at least 6 months. Anemia was defined as hemoglobin (Hb) <11,5 g/dl. HF was classified according to Framingham criteria. Previous history of arterial hypertension, diabetes, dislipemia, chronic renal insufficiency and ACE inhibitors treatment was recorded. Ischaemic and non- ischaemic etiology of cardiopathy was established. Renal disfunction was defined as creatinin concentraction >1.9 mg/dl. Pts with HF were assigned to group A (with anemia) or B (control). Statistical analysis was performed using Pearson’s Chi square, Spearman’s rho, Fisher test and Kaplan Meyer survival function. Results: We evaluated 229 (82,7%) pts with a median follow up of 594 days (range: 1–1129 days). Mean age was 68,02 years (median 71, range: 17–91). 143/229 (62,4%) were male. In 75 /229 (32.75%) cases a Hb < 11,5 g/dl was measured at admission. The mean Hb was 13,1 g/dl for the entire group. Anemia pts showed a mean Hb of 10.6 g/dl. Demographic, clinical and outcome features are shown in table 1.Group A showed a higher number of readmissions because of HF and other cardiac. Conclussions: In our analysis the prevalence of anemia was 33% in pts hospitalized for HF. There was no significant differences among clinical variables between anemic and non-anemic pts. Anemia was associated with worse clinical outcome (Group A pts required more readmissions for HF and other cardiological causes)and all cause mortality. Mean survival was longer in Group B pts.according to Kaplan Meyer analysis. TABLE 1: RESULTS GROUP A (n=75) GROUP B (n= 154) p Male 42 (56%) 101 (65.5%) Mean age (years) 70.38 (R:20–90) 67.1 (R:17–91) Mean Hb (g/dl) 10.6 14.3 Ischaemic cardiopathy 38(50,6%) 78(50.6%) Non ischaemic cardiopathy 41(54,6%) 78 Arterial hypertension 54(72%) 106(68.8%) Diabetes 24(32%) 33(21.4%) Dislipaemia 35(46.6%) 64(41.5%) Chronic renal insufficiency 18(24%) 19(12.3%) 0.03 Previous ACE inhibitors treatment 25(33%) 71(46%) 0.08 Acute pulmonary edema 12(16%) 15(9.7%) Creatinin concentration > 1.9 mg/dl 16(21.3%) 18 (11.6%) Hospitalization days (mean) 9.6 (R: 1–51) 8.1(R:1–59) Readmission for HF 37 190 0.001 Readmission for other cardiologic causes 20 109 0.017 Readmission for non cardiologic diseases 18 58 Mean survival (days) 499 (R:1–1091) 658 (r=1–1129) 0.166 Global mortality 25 (33%) 32(21%) 0.05 HF related mortality 13 (20.9%) 24 (14.3%) Figure Figure