Abstract 10413: Clinical Outcomes with Metformin and Sulfonylurea Initiation Among Patients with Heart Failure and Diabetes: From Get with the Guidelines-Heart Failure

Abstract

Background: Metformin and sulfonylureas are frequently prescribed to patients with diabetes for glycemic control. The impact of these drugs on cardiovascular outcomes among patients with heart failure (HF) and diabetes is unclear. Methods: We evaluated Medicare beneficiaries hospitalized for HF in the Get With The Guidelines-HF Registry between 2006 and 2014 who had diabetes and Part D prescription coverage (n=29,181). Patients with glomerular filtration rate <45 mL/min/1.73m 2 or prescribed metformin or sulfonylurea prior to admission were excluded. In separate analyses for metformin and sulfonylurea, patients filling new prescriptions for each therapy within 90 days of discharge were compared with patients not prescribed therapy. Multivariable models landmarked at 90 days evaluated associations between therapy and mortality and hospitalization for HF (HHF) outcomes over the following 12 months. Secondary analyses were stratified by ejection fraction (EF) ≤40% vs >40%. Results: Of 5,852 patients, 454 (7.8%) were newly prescribed metformin and 504 (8.6%) were newly prescribed sulfonylurea. After adjustment, metformin prescription was associated with reduced risk of composite mortality/HHF, but not individual components (Table) . Associations with mortality/HHF and HHF endpoints were driven by reduced risk among patients with EF>40% (all p for interaction ≤0.04). Sulfonylurea prescription was independently associated with increased risk of mortality, HHF, and the composite. Associations between sulfonylurea prescription and endpoints were consistent regardless of EF (all p for interaction >0.12). Conclusion: Among US patients hospitalized for HF with comorbid diabetes, initiation of metformin was independently associated with improved clinical outcomes, driven by improvements among patients with preserved EF. In contrast, sulfonylurea initiation was associated with adverse clinical outcomes regardless of EF.