title: Acute heart failure in patients with diabetes mellitus: clinical characteristics and predictors of in-hospital mortality.
abstract: OBJECTIVE
  ALARM-HF was an in-hospital observational survey that included 4953 patients admitted for acute heart failure (AHF) in six European countries, Mexico and Australia. This article is a secondary analysis of the survey which evaluates differences in clinical phenotype, treatment regimens and in-hospital outcomes in AHF patients with diabetes mellitus (DM) compared to non-diabetics. The data were collected retrospectively by the investigators, and the diagnosis of AHF (reported at discharge) was based on the definition and classification of ESC guidelines, while the diagnosis of DM was based on medical record (past medical and medication history).
  
  
  RESULTS
  This sub-analysis demonstrates substantial differences regarding both baseline features and in-hospital outcome among diabetic and non-diabetic AHF patients. Diabetic patients (n=2229, 45%) presented more frequently with acute pulmonary edema (p<0.001) than non-diabetics, had more often acute coronary syndrome (p<0.001) as precipitating factors of AHF, and multiple comorbidities such as renal dysfunction (p<0.001), arterial hypertension (p<0.001), anemia (p<0.001) and peripheral vascular disease (p<0.001). All-cause in-hospital mortality of diabetics was higher compared to non-diabetics (11.7% vs 9.8%, p=0.01). The multivariate analysis revealed that older age (p=0.032), systolic blood pressure <100mm Hg (p<0.001), acute coronary syndrome and non compliance as precipitating factors (p=0.05 and p=0.005, respectively), history of arterial hypertension (p=0.022), LVEF<50% (p<0.001), serum creatinine >1.5mg/dl (p=0.029), absence of life saving therapies such as ACE inhibitors/ARBs (p<0.001) and beta-blockers (p=0.014) at admission, as well as absence of interventional treatment by PCI (p<0.001), were independently associated with adverse in-hospital outcome.
  
  
  CONCLUSIONS
  Diabetics with AHF have higher in-hospital mortality than non-diabetics despite their intensive treatment regimens (regarding care for HF and ACS), possibly due to underlying ischemic heart disease and the presence of multiple comorbidities.
authors.affiliation: Heart Failure Clinic and Secondary Cardiology Department, Attikon University Hospital, Athens, Greece. jparissis@yahoo.com
authors.forename: John T
authors.initials: JT
authors.lastname: Parissis
authors.forename: Pinelopi
authors.initials: P
authors.lastname: Rafouli-Stergiou
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Bistola
authors.forename: Maria
authors.initials: M
authors.lastname: Nikolaou
authors.forename: Taly
authors.initials: T
authors.lastname: Meas
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado
authors.forename: Fabio
authors.initials: F
authors.lastname: Vilas-Boas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Paraskevaidis
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
authors.forename: Ferenc
authors.initials: F
authors.lastname: Follath
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends