Association between type-2 diabetes mellitus and post-discharge outcomes in heart failure patients: findings from the RICA registry.
OBJECTIVE
Heart failure (HF) and diabetes are common clinical conditions that may coexist. The main objective was to analyze the association of type-2 diabetes mellitus (T2DM) on prognosis in hospitalized patients with HF.


METHODS
We evaluated the association between T2DM with all-cause mortality and readmissions in the Spanish National Registry on Heart Failure-"Registro Nacional de Insuficiencia Cardiaca" (RICA). This is a multi-center and prospective cohort study that includes patients admitted for decompensated HF from 2008 to 2011. Study endpoints were all-cause mortality and hospital readmission. We determined the adjusted hazard ratio (HR) by a multivariable Cox regression model.


RESULTS
A total of 1082 patients (mean age 77.6±8.5) were included of whom 490 (45.3%) had diabetes and 592 patients (54.7%) had preserved left ventricular ejection fraction (LVEF). During one-year follow-up, 287 patients died (151 patients with diabetes) and 383 patients were readmitted (197 patients with diabetes). After adjusting for baseline characteristics T2DM was significantly associated with all-cause mortality (HR 1.54; 95%CI 1.20-1.97, p=0.001) and readmissions (HR 1.46; 95%CI 1.18-1.80, p<0.001). Age, dementia, peripheral vascular disease, NYHA class, renal insufficiency, hyponatremia and anemia were also independently associated with outcomes. There were no differences in mortality (p=0.415) and readmissions (p=0.514) according to preserved or reduced LVEF.


CONCLUSIONS
T2DM is very common in patients hospitalized for HF. This condition is a strong and independent co-morbidity of all-cause mortality and readmission for both HF with preserved and reduced LVEF.
Internal Medicine Department, Hospital Juan Ramón Jiménez, Huelva, Spain. Electronic address: fjcarrascos@telefonica.net.
Francisco Javier
FJ
Carrasco-Sánchez
Internal Medicine Department, Hospital Regional Universitario, Málaga, Spain.
Ricardo
R
Gomez-Huelgas
Internal Medicine Department, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Francesc
F
Formiga
Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
Alicia
A
Conde-Martel
Internal Medicine Department, Hospital Sant Jaume, Olot, Girona, Spain.
Joan Carles
JC
Trullàs
Internal Medicine Department, Hospital de São João, Porto, Portugal.
Paulo
P
Bettencourt
Internal Medicine Department, Hospital Comarcal de Zafra, Badajoz, Spain.
José Carlos
JC
Arévalo-Lorido
Internal Medicine Department, IMBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain.
Manuel Montero
MM
Pérez-Barquero
D000368:Aged; D000740:Anemia / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000473:pathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D016277:Ventricular Function, Left / Q000502:physiology*
Diabetes; Heart failure; Mortality; Prognosis