Outcomes in diabetic vs nondiabetic patients requiring cardiac resynchronization therapy for heart failure: A meta-analysis

Background Heart failure (HF) affects millions globally, causing severe symptoms and poor prognosis. Cardiac resynchronization therapy (CRT) has been shown to improve heart function and quality of life in HF patients with electrical dyssynchrony, but its effectiveness in diabetic patients remains unclear due to the complexities associated with diabetes. Objectives This study evaluates the impact of diabetes mellitus (DM) on CRT by comparing outcomes between diabetic and non-diabetic patients through a meta-analysis. Methods A comprehensive literature search identified studies on CRT in HF patients, both with and without DM. Pooled risk ratios (RR) and mean differences (MD) were calculated using a random-effects model with 95% confidence intervals (CIs) and statistical significance set at p<0.05. Results Analysis of thirteen observational studies involving 20,073 participants revealed that diabetic patients had a significantly increased risk of all-cause mortality (RR: 1.34; p<0.00001) and cardiovascular death (RR: 1.49; p=0.002) compared to non-diabetic patients. However, no statistically significant differences were observed between groups in the risk of stroke (RR: 3.99; p=0.05), myocardial infarction (RR: 1.16; p=0.30), changes in left ventricular (LV) ejection fraction (p=0.22), LV end-systolic volume (p=0.10), and LV end-diastolic volume (p=0.63). Conclusion These findings suggest that diabetic patients undergoing CRT face a higher risk of all-cause and cardiovascular mortality compared to non-diabetic patients. The increased mortality risk highlights the need for tailored treatment strategies, emphasizing the judicious use of CRT in diabetic patients.