Key result
Insulin therapy after acute heart failure was associated with a higher risk of 1-year readmission for heart failure compared to diabetes patients not on insulin (HR 1.28; 95% CI 1.04-1.59; P=0.022).
Why the study?
Insulin treatment promotes sodium and water retention, weight gain, and hypoglycaemia, but its association with 1-year readmission in patients discharged for acute HF remained to be evaluated.
Does insulin therapy increase the risk of 1-year readmission for heart failure in patients discharged after acute heart failure?
Cohort (n=2,895)
No
Does insulin therapy increase the risk of 1-year readmission for heart failure in patients discharged after acute heart failure?
Hazard Ratio: 1.28 (95% CI 1.04–1.59)
p-value: p=0.022
In patients discharged after acute heart failure, insulin therapy is associated with a significantly increased risk of 1-year heart failure readmission compared to patients with diabetes not on insulin and those without diabetes.
Insulin use was associated with higher 1-year HF readmission in T2DM with AHF; leaves open whether deprescribing or alternatives reduce risk.
AIMS: Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and is related with worse outcomes. Insulin treatment is associated with sodium and water retention, weight gain, and hypoglycaemia-all pathophysiological mechanisms related to HF decompensation. This study aimed to evaluate the association between insulin treatment and the risk of 1 year readmission for HF in patients discharged for acute HF. METHODS AND RESULTS: We prospectively included 2895 consecutive patients discharged after an episode of acute HF in a single tertiary hospital. Multivariable Cox regression, adapted for competing events, was used to assess the association between insulin treatment and 1 year readmission for HF in patients discharged after acute HF. Participants' mean age was 73.4 ± 11.2 years, 50.8% were women, 44.7% had T2DM [including 527 (18.2%) on insulin therapy], and 52.7% had preserved ejection fraction. At 1 year follow-up, 518 (17.9%) patients had died and 693 (23.9%) were readmitted for HF. The crude risk of readmission for HF was higher in patients on insulin, with no differences in 1 year mortality. After multivariable adjustment, patients on insulin were at significantly higher risk of 1 year readmission for HF than patients with diabetes who were not on insulin (hazard ratio 1.28; 95% confidence interval 1.04-1.59, P = 0.022) and patients without diabetes (hazard ratio 1.26; 95% confidence interval 1.02-1.55, P = 0.035). CONCLUSION: Following acute HF, patients with T2DM on insulin therapy are at increased risk of readmission for HF. Further studies unravelling the mechanisms behind this association are warranted.
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Bertomeu‐González et al. (2020) conducted a cohort in Acute heart failure (n=2,895). Insulin treatment vs. Patients with diabetes not on insulin was evaluated on 1 year readmission for HF (HR 1.28, 95% CI 1.04-1.59, p=0.022). Insulin therapy after acute heart failure was associated with a higher risk of 1-year readmission for heart failure compared to diabetes patients not on insulin (HR 1.28; 95% CI 1.04-1.59; P=0.022).
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