title: The impact of thiazolidinedione use on outcomes in ambulatory patients with diabetes mellitus and heart failure.
abstract: OBJECTIVE
  This study sought to examine the relationship between thiazolidinedione (TZD) use and outcomes in ambulatory patients with diabetes and heart failure (HF).
  
  
  BACKGROUND
  Thiazolidinediones have been relatively contraindicated in diabetic patients with HF.
  
  
  METHODS
  We conducted a retrospective study of a national cohort of veterans with HF and diabetes treated in ambulatory clinics at Veterans Affairs medical centers. Patients were classified into those using TZDs and those not using insulin-sensitizing medication based on prescriptions filled 90 days before or 30 days after the index outpatient visit. The outcomes were time to hospitalization for HF and time to death.
  
  
  RESULTS
  Of 7,147 ambulatory HF patients receiving diabetic therapy, 818 (11.4%) were receiving a TZD and 4,700 (65.8%) were not receiving insulin sensitizers. Over 2 years of follow-up, 134 (16.4%) patients receiving TZDs and 741 (15.8%) patients not receiving insulin-sensitizing medications required HF hospitalization (adjusted hazard ratio 1.00, 95% confidence interval 0.81 to 1.24, p = 0.97). A total of 168 (20.5%) patients receiving TZDs and 1,192 (25.4%) patients not receiving insulin-sensitizing medications died (adjusted hazard ratio 0.98, 95% confidence interval 0.81 to 1.17, p = 0.80).
  
  
  CONCLUSIONS
  In ambulatory patients with established HF and diabetes, the use of TZDs was not associated with an increased risk of HF hospitalization or total mortality when compared with those not receiving insulin-sensitizing medications.
authors.affiliation: Winters Center for Heart Failure Research and Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA. daguilar@bcm.edu
authors.forename: David
authors.initials: D
authors.lastname: Aguilar
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
authors.forename: Allison
authors.initials: A
authors.lastname: Pritchett
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Petersen
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D016022:Case-Control Studies; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D045162:Thiazolidinediones / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; C089946:2,4-thiazolidinedione