Impact of diabetes mellitus on mortality in patients with acute heart failure: a prospective cohort study

Min Gyu Kong, Se Yong Jang, Jieun Jang, Hyun-Jai Cho, Sangjun Lee, Sang Eun Lee, Kye Hun Kim, Byung-Su Yoo, Seok-Min Kang, Sang Hong Baek, Dong-Ju Choi, Eun-Seok Jeon, Jae-Joong Kim, Myeong-Chan Cho, Shung Chull Chae, Byung-Hee Oh, Soo Lim, Sue K Park, Hae-Young Lee, Min Gyu Kong, Se Yong Jang, Jieun Jang, Hyun-Jai Cho, Sangjun Lee, Sang Eun Lee, Kye Hun Kim, Byung-Su Yoo, Seok-Min Kang, Sang Hong Baek, Dong-Ju Choi, Eun-Seok Jeon, Jae-Joong Kim, Myeong-Chan Cho, Shung Chull Chae, Byung-Hee Oh, Soo Lim, Sue K Park, Hae-Young Lee

Abstract

Background: Although more than one-third of the patients with acute heart failure (AHF) have diabetes mellitus (DM), it is unclear if DM has an adverse impact on clinical outcomes. This study compared the outcomes in patients hospitalized for AHF stratified by DM and left ventricular ejection fraction (LVEF).

Methods: The Korean Acute Heart Failure registry prospectively enrolled and followed 5625 patients from March 2011 to February 2019. The primary endpoints were in-hospital and overall all-cause mortality. We evaluated the impact of DM on these endpoints according to HF subtypes and glycemic control.

Results: During a median follow-up of 3.5 years, there were 235 (4.4%) in-hospital mortalities and 2500 (46.3%) overall mortalities. DM was significantly associated with increased overall mortality after adjusting for potential confounders (adjusted hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.03-1.22). In the subgroup analysis, DM was associated with higher a risk of overall mortality in heart failure with reduced ejection fraction (HFrEF) only (adjusted HR 1.14, 95% CI 1.02-1.27). Inadequate glycemic control (HbA1c ≥ 7.0% within 1 year after discharge) was significantly associated with a higher risk of overall mortality compared with adequate glycemic control (HbA1c < 7.0%) (44.0% vs. 36.8%, log-rank p = 0.016).

Conclusions: DM is associated with a higher risk of overall mortality in AHF, especially HFrEF. Well-controlled diabetes (HbA1c < 7.0%) is associated with a lower risk of overall mortality compared to uncontrolled diabetes. Trial registration ClinicalTrial.gov, NCT01389843. Registered July 6, 2011. https://ichgcp.net/clinical-trials-registry/NCT01389843.

Keywords: Acute heart failure; Diabetes mellitus; Glycemic control; Left ventricular ejection fraction.

Conflict of interest statement

The authors have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study. KorAHF registry, Korean Acute Heart Failure registry
Fig. 2
Fig. 2
Comparison of in-hospital and overall all-cause mortality as per DM status
Fig. 3
Fig. 3
Kaplan–Meier curves of all-cause mortality according to DM in subgroup by LVEF
Fig. 4
Fig. 4
Overall all-cause mortality as per the prespecified subgroup
Fig. 5
Fig. 5
Overall all-cause mortality as per glycemic control after discharge in patients with DM. *Well-controlled DM as an HbA1c 

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