title: Influence of diabetes on cardiac resynchronization therapy with or without defibrillator in patients with advanced heart failure.
abstract: OBJECTIVE
  We performed a post hoc analysis to determine the influence of cardiac resynchronization therapy with a defibrillator (CRT-D) or without a defibrillator (CRT-P) on outcomes among diabetic patients with advanced heart failure (HF).
  
  
  BACKGROUND
  In patients with systolic HF, diabetes is an independent predictor of morbidity and mortality. No data are available on its impact on CRT-D or CRT-P in advanced HF.
  
  
  METHODS
  The database of the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure trial was examined to determine the influence of CRT (CRT-D and CRT-P) on outcomes among diabetic patients. All-cause mortality or hospitalization, all-cause mortality or cardiovascular hospitalization, all-cause mortality or HF hospitalization, and all-cause mortality were analyzed among diabetic patients (n = 622). A Cox proportional hazard model, adjusting for age, gender, New York Heart Association, ischemic status, body mass index, left ventricular ejection fraction, heart rate, QRS, left or right bundle branch block, blood pressure, comorbidities (renal failure, carotid artery disease, peripheral vascular disease, hypertension, coronary artery bypass grafting, and atrial fibrillation), medications, and device (with or without defibrillator), was used to estimate hazard ratios (HRs) and significance.
  
  
  RESULTS
  The overall outcome of diabetic patients was similar to that of nondiabetic patients in the optimal pharmacologic therapy arm. With CRT, diabetic patients experienced a substantial reduction in all-cause mortality or all-cause hospitalization (HR = 0.77, 95% confidence interval [CI] 62-0.97), all-cause mortality or cardiovascular hospitalization (HR = 0.67, 95% CI 0.53-0.85), all-cause mortality or HF hospitalization (HR = 0.52, 95% CI 0.40-0.69), and all-cause mortality (HR = 0.67, 95% CI 0.45-0.99) compared with optimal pharmacologic therapy. Procedure-related complications and length of stay were identical in diabetic and nondiabetic patients.
  
  
  CONCLUSIONS
  In diabetic patients with advanced HF, there is a substantial benefit from device therapy with significant improvement in all end points.
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
authors.forename: Jalal K
authors.initials: JK
authors.lastname: Ghali
authors.forename: John
authors.initials: J
authors.lastname: Boehmer
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Feldman
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Saxon
authors.forename: Teresa
authors.initials: T
authors.lastname: Demarco
authors.forename: Peter
authors.initials: P
authors.lastname: Carson
authors.forename: Patrick
authors.initials: P
authors.lastname: Yong
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Galle
authors.forename: Jill
authors.initials: J
authors.lastname: Leigh
authors.forename: Fred L
authors.initials: FL
authors.lastname: Ecklund
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bristow
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D003920:Diabetes Mellitus; D003971:Diastole; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006329:Heart Conduction System / Q000503:physiopathology; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013318:Stroke Volume; D013599:Systole; D016896:Treatment Outcome