title: Metformin and risk of long-term mortality following an admission for acute heart failure.
abstract: OBJECTIVE
  Optimal diabetic treatment in patients with established heart failure remains unclear. Metformin has been traditionally considered well tolerated in patients with cardiovascular disease, although there is scarce information regarding the prognostic implications of metformin in acute heart failure. We sought to evaluate the association between metformin therapy and risk of long-term mortality in patients discharged for decompensated heart failure.
  
  
  METHODS
  We included 835 consecutive type 2 diabetic patients discharged from a cardiology department of a third-level center. All-cause mortality was considered as the primary endpoint and the effect of metformin therapy across the most representative subgroups in heart failure as a secondary endpoint. The association between metformin with all-cause mortality was evaluated by using a Cox regression method. Multivariate analysis included solid prognostic covariates in heart failure.
  
  
  RESULTS
  At a mean follow-up of 2.4 ± 2 years, mortality rates were significantly lower in patients on treatment with metformin: 1.34 (1.04-1.65) × 10 vs. 2.24 (2.0-2.51) × 10 person-years (P < 0.001). Kaplan-Meier curve revealed a progressive separation of curves already observed during first months of follow-up (log-rank test P < 0.001). In multivariate analysis, this prognostic association remained significant.
  
  
  CONCLUSIONS
  In this cohort of patients with acute heart failure and diabetes, metformin appears to be well tolerated and may be associated with favorable clinical outcomes.
authors.affiliation: aCardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia bCardiology Department, Hospital Universitario de San Juan, Alicante cCardiology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fácila
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Fabregat-Andrés
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu
authors.forename: Juan P
authors.initials: JP
authors.lastname: Navarro
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Sergio
authors.initials: S
authors.lastname: García-Blas
authors.forename: Ernesto
authors.initials: E
authors.lastname: Valero
authors.forename: Salvador
authors.initials: S
authors.lastname: Morell
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use*; D015999:Multivariate Analysis; D010351:Patient Discharge; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013030:Spain
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin