Contemporary Trends in the All-Cause Mortality of Heart Failure in Diabetic Patients Compared with Non-Diabetic Patients on Medical Management

Abstract

Background: Contemporary long-term trends in the all-cause mortality of heart failure (HF) in diabetic patients, when systematically compared with non-diabetic patients who received pharmacological management, are scarce. Methods: We performed a meta-analysis of HF trials that reported the all-cause mortality of patients with HF and diabetes from 1997-2017, in order to pool all of the available trial evidence on contemporary trends and changes in all-cause mortality. Findings: Fifteen studies met the inclusion criteria, and a total of 53,377 patients with HF, of whom 17,547 (32.89%) had diabetes, were analyzed. In total, and weighted by the follow-up period, the all-cause mortality in the diabetes group was significantly higher than that of non-diabetic patients (P <0.01). The odds ratio (OR) of the all-cause mortality in the diabetes group was 1.32 (95% confidence interval (CI), 1.14-1.53, P <0.01; RD=0.06, lower limit: 0.02, upper limit: 0.09, P <0.01) between 1997 and 2017, which was higher than that in the non-diabetes group; however, the OR was 1.19 (95% CI, 0.92 to 1.54, P=0.18), and the RD=0.03 (P=0.19) in the period from 2007 to 2017. We observed a decrease in the absolute risk difference between the two groups. Interpretation: This meta-analysis suggested that there was a downward trend in the all-cause mortality rate of HF, although it was significantly higher in patients with diabetes than in those without diabetes; and the RD gradually declined from 8% (1997-2006) to 5% (2007-2017). It is a long-term and arduous task to reduce the OR and RD between the groups of patients in the future. Funding: This study received no financial support. Declaration of Interest: The authors declare that there are no conflicts of interest. Ethical Approval: This study involved a post hoc analysis that does not involve ethics.