Key result
Type 2 diabetes mellitus was an independent predictor of increased one-year all-cause mortality in patients with heart failure, including those with reduced (HR 1.33), mid-range (HR 1.13), and preserved (HR 1.21) ejection fraction.
Why the study?
The features and outcomes of heart failure patients with and without type 2 diabetes mellitus, categorized by ejection fraction phenotype (HFpEF, HFmrEF, and HFrEF), are inefficiently explored.
Does the presence of Type 2 Diabetes Mellitus increase one-year all-cause mortality in patients with heart failure across different ejection fraction phenotypes?
Cohort (n=242)
No
Does the presence of Type 2 Diabetes Mellitus increase one-year all-cause mortality in patients with heart failure across different ejection fraction phenotypes?
Type 2 diabetes mellitus is an independent predictor of increased one-year all-cause mortality in patients with heart failure, regardless of whether they have reduced, mildly reduced, or preserved ejection fraction.
Answers are grounded in this paper and cite their sources.
Reinforces the need for aggressive metabolic management across the entire heart failure spectrum; extends prognostic data but leaves.
Introduction: Type 2 diabetes mellitus (T2DM) is frequent in patients with heart failure (HF) and correlated with an increased morbidity and mortality. The features and outcomes of patients with and without T2DM, depending on the HF type (HF with preserved: HFpEF, mid-range: HFmrEF; and reduced ejection fraction: HFrEF), are inefficiently explored. Aim: To explore the impact of T2DM on clinical features and one-year overall mortality in patients with HFrEF, HFmrEF and HFpEF. Material and methods: A prospective, observational study was conducted, including patients with HF at the Department of Cardiology, Clinical Center of Serbia, Belgrade. The enrolment occurred between November 2018 and January 2019. The study outcome was one-year all-cause mortality. Results: Study included 242 patients (mean-age, 71 ± 13 years, men 57%). T2DM was present in 31% of patients. The proportion of T2DM was similar amid patients with HFrEF, HFmrEF, and HFpEF. Regardless of the HF type, patients with T2DM were probably older and had a higher prevalence of myocardial infarction, other types of coronary disorder or peripheral arterial disorder (all p < 0.001). Also, chronic kidney disease was more prevalent in T2DM (p < 0.001). In HFpEF, T2DM patients were commonly female, and usually had hypertension and atrial fibrillation (all p < 0.001). Estimated one-year total mortality rates were significantly higher in T2DM patients. It also emerged as a unique predictor of higher mortality in HFrEF (HR; 1.33; 95% CI; 1.34 - 2.00), HFmrEF (HR; 1.13; 95% CI; 1.0 - 1.24) and HFpEF (HR; 1.21; 95% CI; 1.09 - 1.56), all p < 0.05. Conclusion: Compared with non-diabetics, patients with HF and T2DM are older, with higher prevalence of comorbidities and greater one-year mortality, regardless of HF type. Heart failure is a unique predictor of mortality in all HF types in multivariate analysis. Considering the increased risk, T2DM requires meticulous screening/diagnosis and contemporary treatment to improve outcomes.
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Mrvošević et al. (2021) conducted a cohort in Heart failure (n=242). Type 2 Diabetes Mellitus vs. Without Type 2 Diabetes Mellitus was evaluated on One-year all-cause mortality (HFrEF subgroup) (HR 1.33, 95% CI 1.04-2.00, p=<0.001). Type 2 diabetes mellitus was an independent predictor of increased one-year all-cause mortality in patients with heart failure, including those with reduced (HR 1.33), mid-range (HR 1.13), and preserved (HR 1.21) ejection fraction.
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