title: Prognostic impact of diabetes mellitus in patients with heart failure and preserved ejection fraction: a prospective five-year study.
abstract: OBJECTIVE
  To evaluate the prognostic impact of diabetes mellitus (DM) in patients with heart failure and preserved ejection fraction (HFPEF) DESIGN: A five-year prospective observational study
  
  
  METHODS
  Population of 368 consecutive patients from 11 healthcare establishments
  
  
  METHODS
  All patients hospitalised for a first episode of HFPEF in 2000 in the Somme department, France.
  
  
  METHODS
  Diagnosis of heart failure (HF) was validated during the index hospitalisation by two independent cardiologists. Diabetic and non-diabetic groups were compared. After discharge, patients were managed by the general practitioner or referring cardiologist.
  
  
  METHODS
  Overall and cardiovascular mortality.
  
  
  RESULTS
  The 96 diabetic patients (26%) were younger and had a higher prevalence of clinical coronary artery disease (CAD) than non-diabetic patients. Patients with DM had higher discharge prescription rates of angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, nitrates and statins. During the five-year follow-up, 208 patients died (43.5%). DM was a potent independent predictor of five-year overall mortality (HR 1.77, 95% CI 1.27 to 2.48, p = 0.001). Compared to the expected survival of the age-matched and gender-matched general population, the five-year survival of patients with DM was dramatically lower (32% vs 79%). The five-year relative survival (observed/expected survival) of diabetic patients was lower than that of the non-diabetic group (41% vs 68%). Cardiovascular causes were responsible for >60% of deaths in the DM group. DM was associated with an increased risk of death in patients with clinical CAD (HR 1.82, 95% CI 1.02 to 3.25, p = 0.04), as well as in patients without clinical CAD (HR 1.85, 95% CI 1.22 to 2.82, p = 0.004).
  
  
  CONCLUSIONS
  In patients with HFPEF, DM is a strong predictor of poorer long-term survival.
authors.affiliation: INSERM, ERI 12, University Hospital Amiens, Amiens, France. tribouilloy.christophe@chu-amiens.fr
authors.forename: C
authors.initials: C
authors.lastname: Tribouilloy
authors.forename: D
authors.initials: D
authors.lastname: Rusinaru
authors.forename: H
authors.initials: H
authors.lastname: Mahjoub
authors.forename: J-M
authors.initials: JM
authors.lastname: Tartière
authors.forename: L
authors.initials: L
authors.lastname: Kesri-Tartière
authors.forename: S
authors.initials: S
authors.lastname: Godard
authors.forename: M
authors.initials: M
authors.lastname: Peltier
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome