Is the prognosis in patients with diabetes and heart failure a matter of unsatisfactory management? An observational study from the Swedish Heart Failure Registry.
OBJECTIVE
To analyse the long-term outcome, risk factor panorama, and treatment pattern in patients with heart failure (HF) with and without type 2 diabetes (T2DM) from a daily healthcare perspective.


RESULTS
Patients with (n=8809) and without (n=27,465) T2DM included in the Swedish Heart Failure Registry (S-HFR) 2003–2011 due to a physician-based HF diagnosis were prospectively followed for long-term mortality (median follow-up time: 1.9 years, range 0–8.7 years). Left ventricular function expressed as EF did not differ between patients with and without T2DM. Survival was significantly shorter in patients with T2DM, who had a median survival time of 3.5 years compared with 4.6 years (P<0.0001). In subjects with T2DM. unadjusted and adjusted odds ratios (ORs) for mortality were 1.37 [95% confidence interval (CI) 1.30–1.44) and 1.60 (95% CI 1.50–1.71), and T2DM predicted mortality in all age groups. Ischaemic heart disease was an important predictor for mortality (OR 1.68, 95% CI 1.47–1.94), more abundant in patients with T2DM (59% vs. 45%) among whom only 35% had been subjected to coronary angiography and 32% to revascularization. Evidence-based pharmacological HF treatment was somewhat more extensive in patients with T2DM.


CONCLUSIONS
The combination of T2DM and HF seriously compromises long-term prognosis. Ischaemic heart disease was identified as one major contributor; however, underutilization of available diagnostic and therapeutic facilities for ischaemic heart disease was obvious and may be an important area for future improvement in patients with T2DM and HF.
Isabelle
I
Johansson
Magnus
M
Edner
Ulf
U
Dahlström
Per
P
Näsman
Lars
L
Rydén
Anna
A
Norhammar
D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D015996:Survival Rate; D016277:Ventricular Function, Left / Q000502:physiology