Mortality risk factors in patients with advanced heart failure and diabetes mellitus

Łukasz Siedlecki; Bożena Szyguła‐Jurkiewicz; Wioletta Szczurek; Łukasz Pyka; Jacek Niedziela; Mariusz Gąsior

doi:10.33963/kp.14813

April 26, 2019Kardiologia PolskaOpen Access

Mortality risk factors in patients with advanced heart failure and diabetes mellitus

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Why the study?

Concomitant advanced heart failure and diabetes mellitus has an unfavorable effect on disease course and treatment efficacy, requiring accurate assessment of prognostic factors affecting survival.

What are the independent risk factors for all-cause mortality in patients with advanced heart failure and diabetes mellitus?

Structured PICO

What are the independent risk factors for all-cause mortality in patients with advanced heart failure and diabetes mellitus?

P

Population

367 consecutive patients with advanced heart failure (NYHA class III-IV) and diabetes mellitus, mean age 63.3 ± 10.8 years, 75.7% male. Excluded: patients with haematological disorders, treated with steroids, or with incomplete clinical data.

O

Outcome

Death from all causeshard clinical

In patients with advanced heart failure and diabetes, permanent atrial fibrillation, higher red blood cell distribution width (RDW), and higher platelet-to-lymphocyte ratio (PLR) are independent predictors of long-term mortality.

Implication

May enhance risk stratification in advanced HF with diabetes; leaves open whether targeting AF, RDW, or PLR improves outcomes.

Abstract

BACKGROUND: An accurate assessment of prognosis is an important element of the management of patients with advanced heart failure (HF) and diabetes mellitus (DM), due to the particularly unfavourable effect of concomitance of both diseases on their course and treatment efficacy. Aims: The aim of the study was to determine the prognostic factors affecting survival in patients with HF and DM. METHODS: A retrospective analysis of clinical and laboratory data of 367 consecutive patients with advanced HF (New York Heart Association class III-IV) and DM, hospitalised in a referral centre for interventional cardiology between 2009 and 2013, was performed. Patients with haematological disorders, treated with steroids or with incomplete clinical data were excluded from the analysis. The endpoint of the study was death from all causes. RESULTS: The average patient age was 63.3 ± 10.8 years, 75.7 % of the patients were male. During a mean follow-up of 4.4 ± 1.3 years, the overall mortality rate was 53.7 %. In a multivariate analysis, independent risk factors of death included atrial fibrillation [Hazard Ratio (HR) 1.5730 (95 % Confidence Interval (CI) 1.1417 - 2.1671)); p <0.01], red blood cell distribution width (RDW) [HR 1.0492 (95 % CI 1.0247 - 1.0743); p <0.0001] and platelet-to-lymphocyte ratio (PLR) [HR 1.0045 (95 % CI 1.0032 - 1.0057); p <0.0001]. CONCLUSIONS: Our study showed that permanent atrial fibrillation and two haematological parameters, RDW and PLR, are associated with an increased risk of death in advanced HF patients with concomitant DM in the long-term follow-up.