title: Association Between Diabetes and 1-Year Adverse Clinical Outcomes in a Multinational Cohort of Ambulatory Patients With Chronic Heart Failure: Results From the ESC-HFA Heart Failure Long-Term Registry.
abstract: Diabetes mellitus is associated with an increased risk of cardiovascular disease (CVD) and death. Because the prevalence of diabetes is rising worldwide and chronic heart failure (CHF) is becoming increasingly common with the aging population, it is timely to examine the impact of diabetes per se on 1-year adverse outcomes in patients with CHF.
  
  
  
  We prospectively assessed whether diabetes status independently affected the 1-year risk of all-cause and CVD mortality and first hospitalization for worsening heart failure (HF) in a multinational cohort of 9,428 outpatients with CHF enrolled in the European Society of Cardiology and Heart Failure Association Long-Term Registry.
  
  
  
  Compared with those patients without diabetes, patients with diabetes (n= 3,440, 36.5%) had higher cumulative rates of 1-year all-cause death (9.4% vs. 7.2%; adjusted hazard ratio [HR] 1.28; 95% CI 1.07-1.54), CVD death (4.8% vs. 3.8%; adjusted HR 1.28; 95% CI 0.99-1.66), and HF hospitalization (13.8% vs. 9.3%; adjusted HR 1.37; 95% CI 1.17-1.60), all independent of age, sex, BMI, smoking, systolic blood pressure, estimated glomerular filtration rate, hemoglobin, HF etiology, left ventricular ejection fraction, hypertension, statin use, and prior stroke or chronic obstructive pulmonary disease. Among CHF patients with HbA1cmeasurements available at baseline (n= 2,567), there was a significant and independent association between increasing HbA1clevels and the risk of 1-year survival outcomes.
  
  
  
  The presence of diabetes markedly increases the risk of 1-year adverse clinical outcomes in outpatients with CHF independent of multiple common risk factors. More effective and personalized treatment for diabetes should be considered in this particularly high-risk patient population.
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Dauriz
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
authors.affiliation: EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Laroche
authors.affiliation: Division of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Salvatore Maugeri, Veruno, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Temporelli
authors.affiliation: Department of Cardiology and Industrial Research and Technology Transfer Laboratory Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.affiliation: Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Anker
authors.affiliation: Monash University, Melbourne, Victoria, Australia.|University of Warwick, Coventry, U.K.
authors.forename: Andrew
authors.initials: A
authors.lastname: Coats
authors.affiliation: Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.affiliation: Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruña, La Coruña, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Crespo-Leiro
authors.affiliation: INSERM 942, Hôpital Lariboisière, Université Paris Diderot, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: Department of Cardiology, Polichirurgico Hospital G. da Saliceto, Piacenza, Italy.
authors.forename: Massimo F
authors.initials: MF
authors.lastname: Piepoli
authors.affiliation: EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France amaggioni@escardio.org.|ANMCO Research Center, Florence, Italy.
authors.forename: Aldo P
authors.identifier: 0000-0003-2764-6779
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Department of Cardiology and Industrial Research and Technology Transfer Laboratory Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.|Department of Cardiology and Industrial Research and Technology Transfer Laboratory Centre, University Hospital of Ferrara, Ferrara, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D002908:Chronic Disease; D048909:Diabetes Complications / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013997:Time Factors