Incidence of Hospitalization for Heart Failure and Case-Fatality Among 3.25 Million People With and Without Diabetes Mellitus
David A McAllister, Stephanie H Read, Jan Kerssens, Shona Livingstone, Stuart McGurnaghan, Pardeep Jhund, John Petrie, Naveed Sattar, Colin Fischbacher, Soren Lund Kristensen, John McMurray, Helen M Colhoun, Sarah H Wild, David A McAllister, Stephanie H Read, Jan Kerssens, Shona Livingstone, Stuart McGurnaghan, Pardeep Jhund, John Petrie, Naveed Sattar, Colin Fischbacher, Soren Lund Kristensen, John McMurray, Helen M Colhoun, Sarah H Wild
Abstract
Background: Recent clinical trials of new glucose-lowering treatments have drawn attention to the importance of hospitalization for heart failure as a complication of diabetes mellitus. However, the epidemiology is not well described, particularly for type 1 diabetes mellitus. We examined the incidence and case-fatality of heart failure hospitalizations in the entire population aged ≥30 years resident in Scotland during 2004 to 2013.
Methods: Date and type of diabetes mellitus diagnosis were linked to heart failure hospitalizations and deaths using the national Scottish registers. Incidence rates and case-fatality were estimated in regression models (quasi-Poisson and logistic regression respectively). All estimates are adjusted for age, sex, socioeconomic status, and calendar-year.
Results: Over the 10-year period of the study, among 3.25 million people there were 91, 429, 22 959, and 1313 incident heart failure events among those without diabetes mellitus, with type 2, and type 1 diabetes mellitus, respectively. The crude incidence rates of heart failure hospitalization were therefore 2.4, 12.4, and 5.6 per 1000 person-years for these 3 groups. Heart failure hospitalization incidence was higher in people with diabetes mellitus, regardless of type, than in people without. Relative differences were smallest for older men, in whom the difference was nonetheless large (men aged 80, rate ratio 1.78; 95% CI, 1.45-2.19). Rates declined similarly, by 0.2% per calendar-year, in people with type 2 diabetes mellitus and without diabetes mellitus. Rates fell faster, however, in those with type 1 diabetes mellitus (2.2% per calendar-year, rate ratio for type 1/calendar-year interaction 0.978; 95% CI, 0.959-0.998). Thirty-day case-fatality was similar among people with type 2 diabetes mellitus and without diabetes mellitus, but was higher in type 1 diabetes mellitus for men (odds ratio, 0.96; 95% CI, 0.95-0.96) and women (odds ratio, 0.98; 95% CI, 0.97-0.98). Case-fatality declined over time for all groups (3.3% per calendar-year, odds ratio per calendar-year 0.967; 95% CI, 0.961-0.973).
Conclusions: Despite falling incidence, particularly in type 1 diabetes mellitus, heart failure remains ≈2-fold higher than in people without diabetes mellitus, with higher case-fatality in those with type 1 diabetes mellitus. These findings support the view that heart failure is an under-recognized and important complication in diabetes mellitus, particularly for type 1 disease.
Keywords: diabetes mellitus; electronic health records; epidemiology; heart failure; incidence; mortality; registries.
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References
- Cavender MA, Steg PG, Smith SC, Jr, Eagle K, Ohman EM, Goto S, Kuder J, Im K, Wilson PW, Bhatt DL REACH Registry Investigators. Impact of diabetes mellitus on hospitalization for heart failure, cardiovascular events, and death: outcomes at 4 years from the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Circulation. 2015;132:923–931. doi: 10.1161/CIRCULATIONAHA.114.014796.
- Rosengren A, Vestberg D, Svensson AM, Kosiborod M, Clements M, Rawshani A, Pivodic A, Gudbjörnsdottir S, Lind M. Long-term excess risk of heart failure in people with type 1 diabetes: a prospective case-control study. Lancet Diabetes Endocrinol. 2015;3:876–885. doi: 10.1016/S2213-8587(15)00292-2.
- Shah AD, Langenberg C, Rapsomaniki E, Denaxas S, Pujades-Rodriguez M, Gale CP, Deanfield J, Smeeth L, Timmis A, Hemingway H. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people. Lancet Diabetes Endocrinol. 2015;3:105–113. doi: 10.1016/S2213-8587(14)70219-0.
- Seferović PM, Petrie MC, Filippatos GS, Anker SD, Rosano G, Bauersachs J, Paulus WJ, Komajda M, Cosentino F, de Boer RA, Farmakis D, Doehner W, Lambrinou E, Lopatin Y, Piepoli MF, Theodorakis MJ, Wiggers H, Lekakis J, Mebazaa A, Mamas MA, Tschöpe C, Hoes AW, Seferović JP, Logue J, McDonagh T, Riley JP, Milinković I, Polovina M, van Veldhuisen DJ, Lainscak M, Maggioni AP, Ruschitzka F, McMurray JJV. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20:853–872. doi: 10.1002/ejhf.1170.
- ISD Services | Electronic Data Research and Innovation Service (eDRIS) | Data for Research | ISD Scotland. . Accessed July 17, 2018.
- McAllister DA. Analysis code for manuscript Incidence of hospitalisation for heart failure and case-fatality among 3.25 million people with and without diabetes. . Accessed July 17, 2018.
- Anwar H, Fischbacher CM, Leese GP, Lindsay RS, McKnight JA, Wild SH Scottish Diabetes Research Network Epidemiology Group. Assessment of the under-reporting of diabetes in hospital admission data: a study from the Scottish Diabetes Research Network Epidemiology Group. Diabet Med. 2011;28:1514–1519. doi: 10.1111/j.1464-5491.2011.03432.x.
- Scottish Government SAH. Evaluation of Statistical Techniques in the Scottish Index of Multiple Deprivation. 2005. . Accessed July 17, 2018.
- Livingstone SJ, Levin D, Looker HC, Lindsay RS, Wild SH, Joss N, Leese G, Leslie P, McCrimmon RJ, Metcalfe W, McKnight JA, Morris AD, Pearson DWM, Petrie JR, Philip S, Sattar NA, Traynor JP, Colhoun HM. Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008–2010. JAMA. 2015;313:37. doi: 10.1001/jama.2014.16425.
- Read SH, McAllister DA, Colhoun HM, Farran B, Fischbacher C, Kerssens JJ, Leese GP, Lindsay RS, McCrimmon RJ, McGurnaghan S, Philip S, Sattar N, Wild SH Scottish Diabetes Research Network Epidemiology Group. Incident ischaemic stroke and type 2 diabetes: trends in incidence and case fatality in Scotland 2004–2013. Diabet Med J Br Diabet Assoc. 2018;35:99–106. doi: 10.1111/dme.13528.
- Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. US: Lippincott Williams & Wilkins; 2008.
- Greenberg BH, Abraham WT, Albert NM, Chiswell K, Clare R, Stough WG, Gheorghiade M, O’Connor CM, Sun JL, Yancy CW, Young JB, Fonarow GC. Influence of diabetes on characteristics and outcomes in patients hospitalized with heart failure: a report from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J. 2007;154:277.e1–277.e8. doi: 10.1016/j.ahj.2007.05.001.
- MacDonald MR, Jhund PS, Petrie MC, Lewsey JD, Hawkins NM, Bhagra S, Munoz N, Varyani F, Redpath A, Chalmers J, MacIntyre K, McMurray JJ. Discordant short- and long-term outcomes associated with diabetes in patients with heart failure: importance of age and sex: a population study of 5.1 million people in Scotland. Circ Heart Fail. 2008;1:234–241. doi: 10.1161/CIRCHEARTFAILURE.108.794008.
- Lind M, Bounias I, Olsson M, Gudbjörnsdottir S, Svensson AM, Rosengren A. Glycaemic control and incidence of heart failure in 20,985 patients with type 1 diabetes: an observational study. Lancet. 2011;378:140–146. doi: 10.1016/S0140-6736(11)60471-6.
- Konduracka E, Gackowski A, Rostoff P, Galicka-Latala D, Frasik W, Piwowarska W. Diabetes-specific cardiomyopathy in type 1 diabetes mellitus: no evidence for its occurrence in the era of intensive insulin therapy. Eur Heart J. 2007;28:2465–2471. doi: 10.1093/eurheartj/ehm361.
- Karamitsos TD, Tsapas A, Arnold JR. Diabetic cardiomyopathy: a controversial entity. Eur Heart J. 2008;29:564. author reply 565. doi: 10.1093/eurheartj/ehm590.
- Tillquist MN, Maddox TM. Update on diabetic cardiomyopathy: inches forward, miles to go. Curr Diab Rep. 2012;12:305–313. doi: 10.1007/s11892-012-0274-7.
- Gilbert RE. Heart failure: fatal, forgotten, and frequent in type 1 diabetes too. Lancet Diabetes Endocrinol. 2015;3:832–834. doi: 10.1016/S2213-8587(15)00329-0.
- Barasa A, Schaufelberger M, Lappas G, Swedberg K, Dellborg M, Rosengren A. Heart failure in young adults: 20-year trends in hospitalization, aetiology, and case fatality in Sweden. Eur Heart J. 2014;35:25–32. doi: 10.1093/eurheartj/eht278.
- Win TT, Davis HT, Laskey WK. Mortality among patients hospitalized with heart failure and diabetes mellitus: results from the National Inpatient Sample 2000–2010. Circ Heart Fail. 2016;9:e003023. doi: 10.1161/CIRCHEARTFAILURE.115.003023.
- Dunlay SM, Weston SA, Jacobsen SJ, Roger VL. Risk factors for heart failure: a population-based case-control study. Am J Med. 2009;122:1023–1028. doi: 10.1016/j.amjmed.2009.04.022.
- Grodin JL, Tang WH. Treatment strategies for the prevention of heart failure. Curr Heart Fail Rep. 2013;10:331–340. doi: 10.1007/s11897-013-0154-8.
- NHS ISD Scotland. ISD Services | Data Quality Assurance | ISD Scotland. . Accessed July 17, 2018.
- Stelzle D, Shah ASV, Anand A, Strachan FE, Chapman AR, Denvir MA, Mills NL, McAllister DA. High-sensitivity cardiac troponin I and risk of heart failure in patients with suspected acute coronary syndrome: a cohort study. Eur Heart J Qual Care Clin Outcomes. 2018;4:36–42. doi: 10.1093/ehjqcco/qcx022.
Source: PubMed