Metformin use and mortality in ambulatory patients with diabetes and heart failure.
BACKGROUND
Despite the common coexistence of diabetes and heart failure (HF), the optimal medial treatment of diabetes in HF patients has not been well studied. We sought to compare the association between metformin use and clinical outcomes in a cohort of ambulatory patients with diabetes and established HF.


RESULTS
Using propensity score-matched samples, we examined the association between metformin use and the risk of death or risk of hospitalization in a national cohort of 6185 patients with HF and diabetes treated in ambulatory clinics at Veteran Affairs medical centers. In this cohort, 1561 (25.2%) patients were treated with metformin. At 2 years of follow-up, death occurred in 246 (15.8%) patients receiving metformin and in 1177 (25.5%) patients not receiving metformin (P<0.001). In the propensity score-matched analysis (n=2874), death occurred in 232 (16.1%) patients receiving metformin compared with 285 (19.8%) patients not receiving metformin (hazard ratio, 0.76; 95% confidence interval, 0.63 to 0.92; P<0.01). In propensity score-matched analyses, HF hospitalization or total hospitalization rates were not significantly different between individuals treated with metformin compared with those not treated with metformin (hazard ratio, 0.93; 95% confidence interval, 0.74 to 1.18; and hazard ratio, 0.94; 95% confidence interval, 0.83 to 1.07, respectively).


CONCLUSIONS
Metformin therapy was associated with lower rates of mortality in ambulatory patients with diabetes and HF. Future prospective studies are necessary to define the optimal therapy for diabetic patients with HF.
Winters Center for Heart Failure Research and Section of Cardiology, Department of Medicine, Baylor College of Medicine, 1709 Dryden Street, Houston, TX 77030, USA. daguilar@bcm.edu
David
D
Aguilar
Wenyaw
W
Chan
Biykem
B
Bozkurt
Kumudha
K
Ramasubbu
Anita
A
Deswal
D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D008687:Metformin