title: Congestive heart failure presence predicts delayed healing of foot ulcers in diabetes: An audit from a multidisciplinary high-risk foot clinic.
abstract: OBJECTIVE
  This retrospective study aimed to investigate both established and less well-explored factors as potential predictive variables for failed and delayed ulcer healing.
  
  
  METHODS
  Patients with type 1 or 2 diabetes with foot ulceration presenting consecutively to, and then subsequently managed at, a multidisciplinary, high-risk foot clinic were followed until ulcer healing, amputation or death. Data comprised prospective standardised documentation at each visit and retrospective collection from hospital records, and included patient demographics, comorbidities, laboratory variables, and ulcer infection, depth and area at each presentation. Multiple regression analysis was used to determine independent predictors of failure to heal and delayed healing.
  
  
  RESULTS
  Of the 107 consecutive patients studied, 95 (89%) healed overall, 50 (47%) had healed in 12 weeks and the mean healing rate was a 10% decrease in ulcer area per week. Amongst all variables examined, comorbid congestive heart failure (CHF) was the only factor independently predictive of all measured outcomes of failure to heal overall, delayed healing at 12 weeks, and reduced healing rate. Ulcer infection at presentation, longer duration of antibiotic use, and liver enzyme abnormalities of raised ALT and AST:ALT<1 (each suggestive of non-alcoholic fatty liver disease), were also predictive of poor ulcer outcomes.
  
  
  CONCLUSIONS
  Comorbid congestive cardiac failure is predictive of delayed foot ulcer healing rate as well as a lower probability of healing overall. Liver enzyme abnormalities also predicted delayed ulcer healing outcomes. The mechanisms underlying these associations with foot ulcer outcomes in diabetes are unclear. Further studies are needed to determine the role of systematic routine documentation of heart failure and its severity, and then targeting of heart failure to potentially aid the management of foot ulcers in diabetes.
authors: Sydney Medical School, University of Sydney.
authors: Yoon Ji Jina
authors: YJ
authors: Rhou
authors: Sydney Medical School, University of Sydney.
authors: F R
authors: FR
authors: Henshaw
authors: Sydney Medical School, University of Sydney; Diabetes Centre, Dept of Endocrinology, Royal Prince Alfred Hospital, Sydney.
authors: M J
authors: MJ
authors: McGill
authors: Sydney Medical School, University of Sydney; Diabetes Centre, Dept of Endocrinology, Royal Prince Alfred Hospital, Sydney. Electronic address: stephen.twigg@sydney.edu.au.
authors: S M
authors: SM
authors: Twigg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D017719:Diabetic Foot / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D011379:Prognosis; D012189:Retrospective Studies; D014945:Wound Healing
keywords: Congestive cardiac failure; Diabetes and foot ulcers; Healing; Heart failure; Non-alcoholic fatty liver disease