title: Chronic heart failure-related interventions after starting rosiglitazone in patients receiving insulin.
abstract: OBJECTIVE
  To determine whether rosiglitazone is associated with the onset or worsening of chronic heart failure (CHF) when administered to patients with type 2 diabetes mellitus who receive insulin.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Veterans Affairs medical center.
  
  
  METHODS
  One hundred thirty-nine patients who received insulin for treatment of type 2 diabetes mellitus and had rosiglitazone added to their drug regimens.
  
  
  METHODS
  Medical records were reviewed for 6 months before and 6 months after each patient's first rosiglitazone prescription. Records were assessed for the diagnosis of CHF and documented patient complaints of CHF symptoms requiring a medical intervention (unscheduled primary care or emergency room visit, start or dosage adjustment of CHF pharmacotherapy, or hospitalization).
  
  
  RESULTS
  A diagnosis of CHF was documented in Thirty-five (25%) patients in the preindex period (before receiving rosiglitazone) versus 42 (30%) in the postindex period (after receiving rosiglitazone). Fifty (36%) patients received a medical intervention for CHF signs or symptoms in the postindex period compared with only 20 (14%) in the preindex period (p<0.0001). Of the 50 patients requiring a medical intervention in the postindex period, 33 (66%) had not required an intervention in the preindex period. The most common symptom was lower extremity edema; this occurred in 25 (18%) patients in the preindex period and 50 (36%) patients in the postindex period (p<0.0001).
  
  
  CONCLUSIONS
  More patients were diagnosed with CHF during the 6 months after rosiglitazone was added to their drug regimens than in the previous 6 months, when these patients received insulin but not rosiglitazone. In addition, more medical interventions related to CHF occurred after administration of rosiglitazone. Data from this study appear to support the Food and Drug Administration's warning of an increased risk of cardiac failure in patients receiving concurrent treatment with rosiglitazone and insulin.
authors.affiliation: Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois 60141, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Marceille
authors.forename: Janelle A
authors.initials: JA
authors.lastname: Goins
authors.forename: Rita
authors.initials: R
authors.lastname: Soni
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Biery
authors.forename: Todd A
authors.initials: TA
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000209:etiology* / Q000628:therapy; D002908:Chronic Disease; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D045162:Thiazolidinediones; D000077154:Rosiglitazone