Key result
Cardiac resynchronization therapy in heart failure patients was associated with significantly higher all-cause mortality in diabetics compared to non-diabetics (24.3% vs 20.4%, OR 1.28).
Why the study?
Does cardiac resynchronization therapy reduce mortality in heart failure patients with and without diabetes mellitus?
Meta-Analysis (n=2,923)
Does cardiac resynchronization therapy reduce mortality in heart failure patients with and without diabetes mellitus?
Effect estimate: OR 1.28 (95% CI 1.06-1.55)
Absolute Event Rate: 24.3% vs 20.4%
p-value: p=0.010
CRT reduces mortality in heart failure patients regardless of diabetes status, though diabetic patients have a higher absolute mortality post-CRT compared to non-diabetics.
Diabetics may warrant closer post-CRT monitoring than non-diabetics; extends evidence on diabetes as an adverse prognostic marker in HF.
BACKGROUND: Diabetes mellitus is an independent risk factor of increased morbidity and mortality in patients with heart failure. Cardiac resynchronization therapy (CRT), a pacemaker-based therapy for dyssynchronous heart failure, improves cardiac performance and quality of life, but its effect on mortality in patients with diabetes is uncertain. METHODS: We performed a meta-analysis of results from randomized controlled trials (RCTs) of the long-term outcome of cardiac resynchronization therapy for heart failure in diabetic and non-diabetic patients. Literature search of MEDLINE via Pubmed for reports of randomized controlled trials of Cardiac resynchronization for chronic symptomatic left-ventricular dysfunction in patients with and without diabetes mellitus, with death as the outcome. Relevant data were analyzed by use of a random-effects model. Reports published from 1994 to 2011 that described RCTs of CRT for treating chronic symptomatic left ventricular dysfunction in patients with and without diabetes, with all-cause mortality as an outcome. RESULTS: A total of 5 randomized controlled trials met the inclusion criteria, for 2,923 patients. The quality of studies was good to moderate. Cardiac resynchronization significantly reduced the mortality for heart failure patients with or without diabetes mellitus. Mortality was 24.3% for diabetic patients with heart failure and 20.4 % for non-diabetics (odds ratio 1.28, 95% confidence interval 1.06-1.55; P = 0.010). CONCLUSIONS: Cardiac resynchronization therapy (CRT) may reduce mortality from progressive heart failure in patients with or without diabetes mellitus, but mortality may be higher for patients with than without diabetes after CRT for heart failure.
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Sun et al. (2015) conducted a meta-analysis in Heart failure (n=2,923). Cardiac resynchronization therapy (CRT) in diabetic patients vs. Cardiac resynchronization therapy (CRT) in non-diabetic patients was evaluated on All-cause mortality (OR 1.28, 95% CI 1.06-1.55, p=0.010). Cardiac resynchronization therapy in heart failure patients was associated with significantly higher all-cause mortality in diabetics compared to non-diabetics (24.3% vs 20.4%, OR 1.28).
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