title: Prevalence, clinical characteristics and outcome in patients with chronic heart failure and diabetes.
abstract: BACKGROUND
  Chronic heart failure (CHF) and diabetes mellitus portend high morbidity and mortality because of an interrelated pathophysiologic process. This large cohort study aimed to analyze the prevalence, clinical characteristics and long-term outcome of patients with CHF and diabetes.
  
  
  METHODS
  A total of 1119 patients with NYHA functional class II - IV and left ventricular ejection fraction (LVEF) < 45% between January 1995 and May 2009 were recruited. Clinical variables, biochemical and echocardiographic measurements were retrospectively reviewed, and composite major cardiac events (MCE) including death, heart transplantation, and refractory heart failure requiring multiple hospitalizations were recorded.
  
  
  RESULTS
  The prevalence of CHF with diabetes was progressively increased with time (16.9% in 1995 - 1999; 20.4% in 2000 - 2004, and 29.1% in 2005 - 2009) and age (18.5% in < 60 years, 26.6% in 60 - 80 years, and 26.6% in > 80 years). Compared with CHF patients without diabetes, those with diabetes had worse cardiac function, more abnormal biochemical changes, and higher mortality. Treatment with glucose-lowering agents significantly improved LVEF and decreased MCE. An elevated serum HbA1c level was associated with large left ventricular end-systolic diameter (P < 0.05), decreased LVEF (P < 0.01) and reduced survival (P < 0.05). Multivariable Logistic regression analysis revealed that after adjustment for confounding factors, NYHA functional class (OR 2.65, 95%CI 1.14 - 6.16, P = 0.024) and HbA1c level >or= 7% (OR 2.78, 95%CI 1.00 - 7.68, P = 0.049) were independent risk factors for adverse outcomes in CHF patients with diabetes.
  
  
  CONCLUSIONS
  Prevalence of CHF with diabetes was increasing during past decades, and patients with CHF and diabetes had worse clinical profiles and prognosis. Aggressive anti-CHF and diabetes therapies are needed to improve overall outcomes for these patients.
authors.affiliation: Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Shi
authors.forename: Ling-jie
authors.initials: LJ
authors.lastname: Wang
authors.forename: Dan-feng
authors.initials: DF
authors.lastname: Hu
authors.forename: Jin-ping
authors.initials: JP
authors.lastname: Li
authors.forename: Tian-qi
authors.initials: TQ
authors.lastname: Zhu
authors.forename: Ying
authors.initials: Y
authors.lastname: Shan
authors.forename: Jian-rong
authors.initials: JR
authors.lastname: Zhao
authors.forename: Feng-ru
authors.initials: FR
authors.lastname: Zhang
authors.forename: Wei-feng
authors.initials: WF
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications / Q000453:epidemiology / Q000209:etiology*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016277:Ventricular Function, Left
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human