PURPOSE: The co-morbidity of diabetes in patients with cardiovascular disease results in adverse outcomes. Although the effects of diabetes in patients with heart failure are less understood than with coronary artery disease, diabetes is an independent risk factor for the development of heart failure. Diabetics have 2-5 times higher likelihood of developing symptomatic heart failure independent of coexisting hypertension and coronary artery disease. Both diabetes and heart failure share pathologic processes, including neurohormonal activation, endothelial dysfunction, and increased oxidative stress.
METHODS: We sought to characterize the impact of diabetes in an outpatient heart failure population by analyzing data from our Clinical Information Manager for Heart Failure (CIM-HF) database.
RESULTS: From our database, 98(44%) patients had diabetes. Diabetic and non-diabetic heart failure patients received similar therapy with ACE inhibitors, beta blockers, aldosterone antagonists, diuretics, and digoxin. Diabetic patients were treated with insulin (35%), sulfonylureas (46%), biguanides (20%), and thiazolidinediones (9%).There were no differences in age (p=0.167), etiology of heart failure (p=0.18), systolic blood pressure (p=0.172), creatinine clearance (p=0.817) and pro-BNP levels (p=0.408). Diabetics had more advanced heart failure symptoms (p=0.008), larger body mass index (32% vs. 28%, p=0.200), a greater left ventricular mass index (110gm/m vs. 101gm/m, p=0.049) and more atrial fibrillation (34% vs. 18%, p=0.001) with no difference in left atrial diameter (4.5cm vs. 4.37cm, p=0.200).When analyzing hospitalizations for the past year, rates were significantly different between the two groups (1.6 average admissions for diabetics versus 1.0 for non-diabetics, p=0.019, 95% CI=0.94-0.08).
CONCLUSION: In our outpatient chronic heart failure clinic, diabetics received similar treatment compared to non-diabetics. Diabetics exhibit more frequent hospitalizations, a higher incidence of atrial fibrillation despite no difference in left atrial size, and an increased left ventricular mass index, despite similar pro-BNP levels and blood pressure.
CLINICAL IMPLICATIONS: Diabetics with chronic heart failure have higher hospitalization rates compared to non diabetics inspite of similar baseline therapy.
DISCLOSURE: Jun Chiong, None.