Abstract
BackgroundPrevalent diabetes at the time of heart failure (HF) diagnosis is associated with a higher risk of death, but the incidence and prognostic importance of new-onset diabetes in patients with established HF remains unknown.MethodsPatients with a first hospitalization for HF in the period 2003–2014 were included and stratified according to history of diabetes. Annual incidence rates of new-onset diabetes were calculated and time-dependent multivariable Cox regression models were used to compare the risk of death in patients with prevalent and new-onset diabetes with patients without diabetes as reference. The model was adjusted for age, sex, duration of HF, educational level and comorbidity. Covariates were continuously updated throughout follow-up.ResultsA total of 104,522 HF patients were included in the study, of which 21,216 (19%) patients had diabetes at baseline, and 8164 (10%) developed new-onset diabetes during a mean follow-up of 3.9 years. Patients with new-onset diabetes and prevalent diabetes were slightly younger than patients without diabetes (70 vs. 74 and 77, respectively), more likely to be men (62% vs. 60% and 54%), and had more comorbidities expect for ischemic heart disease, hypertension and chronic kidney disease which were more prevalent among patients with prevalent diabetes. Incidence rates of new-onset diabetes increased from around 2 per 100 person-years in the first years following HF hospitalization up to 3 per 100 person-years after 5 years of follow-up. A total of 61,424 (59%) patients died during the study period with event rates per 100 person-years of 21.5 for new-onset diabetes, 17.9 for prevalent diabetes and 13.9 for patients without diabetes. Compared to patients without diabetes, new-onset diabetes was associated with a higher risk of death (adjusted HR 1.47; 95% CI 1.42–1.52) and prevalent diabetes was associated with an intermediate risk (HR 1.19; 95% CI, 1.16–1.21).ConclusionFollowing the first HF hospitalization, the incidence of new-onset diabetes was around 2% per year, rising to 3% after 5 years of follow-up. New-onset diabetes was associated with an increased risk of death, compared to HF patients with prevalent diabetes (intermediate risk) and HF patients without diabetes.
Highlights
Prevalent diabetes at the time of heart failure (HF) diagnosis is associated with a higher risk of death, but the incidence and prognostic importance of new-onset diabetes in patients with established HF remains unknown
Despite previous studies establishing the detrimental prognosis of patients with HF and diabetes, the interplay of this bidirectional relationship has not been fully elucidated the mortality risk associated with new-onset diabetes vs. prevalent diabetes in patients with HF has never been investigated
Patients with new-onset diabetes and prevalent diabetes were slightly younger than patients without diabetes (70 vs. 74 and 77, respectively), more likely to be men (62% vs. 60% and 54%), and had more comorbidities except for ischemic heart disease, hypertension and chronic kidney disease which were more present in patients with prevalent diabetes All evaluated pharmacotherapy, including evidence-based HF medication was more widely used among patients with prevalent diabetes than in patient with new-onset or no diabetes except for beta blockers (68% vs. 63% vs. %), digoxin (34% vs. 22% vs. 24%) and mineralocorticoid receptor antagonists (MRA) (32% vs. 28% vs. 23%) which were more likely to be given to patients with new-onset diabetes
Summary
Prevalent diabetes at the time of heart failure (HF) diagnosis is associated with a higher risk of death, but the incidence and prognostic importance of new-onset diabetes in patients with established HF remains unknown. Hyperglycemia has been associated with changes in cardiac structure, cardiac function, increased atherosclerosis, and the existence of a specific diabetic cardiomyopathy phenotype has been suggested [2,3,4]. Despite previous studies establishing the detrimental prognosis of patients with HF and diabetes, the interplay of this bidirectional relationship has not been fully elucidated the mortality risk associated with new-onset diabetes vs prevalent diabetes in patients with HF has never been investigated. Our purpose was to investigate the incidence of new-onset diabetes following a diagnosis of HF and compare its prognostic impact on the risk of death with that of HF patients with prevalent diabetes and without diabetes
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