Meta-Analysis Comparing Risk for Adverse Outcomes After Left Ventricular Assist Device Implantation in Patients With Versus Without Diabetes Mellitus
Patients with diabetes mellitus (DM) are known to have reduced life expectancy and be at increased risk for multiple morbidities including serious infection. However, published data on DM outcomes after left ventricular assist device (LVAD) implantation are sparse, inconsistent and individual studie...
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| Veröffentlicht in: | The American journal of cardiology 2019-12, Vol.124 (12), p.1918-1923 |
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| container_issue | 12 |
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| container_title | The American journal of cardiology |
| container_volume | 124 |
| creator | Lateef, Noman Usman, Muhammad Shariq Colombo, Paolo C. Ahmed, Saba Khan, Muhammad Shahzeb Khan, Safi U. Garan, Arthur R. Yuzefpolskaya, Melana Demmer, Ryan T. |
| description | Patients with diabetes mellitus (DM) are known to have reduced life expectancy and be at increased risk for multiple morbidities including serious infection. However, published data on DM outcomes after left ventricular assist device (LVAD) implantation are sparse, inconsistent and individual studies are small with limited power. We conducted a systematic review and meta-analysis to compare survival and adverse events post-LVAD in DM versus non-DM (NDM) patients. Medline, Scopus, and Cochrane Central databases were searched for studies comparing outcomes in DM and NDM patients who underwent LVAD implantation for advanced heart failure. Results were reported as random effect risk ratios (RR) with 95% confidence intervals. We identified 5 retrospective cohort studies, at low risk of bias, reporting on 1,351 patients (n = 488 DM). There was increased 30-day mortality (RR 1.57 [1.00, 2.47]; p = 0.05; I2 = 0%) among DM versus NDM. The DM and NDM groups did not differ significantly in terms of 1-year mortality (RR 1.15 [0.98, 1.35]; p = 0.08; I2 = 39%), device-related infection (RR 1.05 [0.92, 1.19]; p = 0.88; I2 = 0%), ischemic stroke (RR 1.29 [0.91, 1.83]; p = 0.69; I2 = 0%), hemorrhagic stroke (RR 1.10 [0.42, 2.83]; p = 0.85; I2 = 69%), or bleeding (RR 1.06 [0.80, 1.40]; p = 0.70; I2 = 27%). After LVAD implantation, patients with DM, versus patients without, have a modestly elevated 30-day mortality rate. However, 1-year mortality and morbidity did not differ. |
| doi_str_mv | 10.1016/j.amjcard.2019.09.021 |
| format | Article |
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However, published data on DM outcomes after left ventricular assist device (LVAD) implantation are sparse, inconsistent and individual studies are small with limited power. We conducted a systematic review and meta-analysis to compare survival and adverse events post-LVAD in DM versus non-DM (NDM) patients. Medline, Scopus, and Cochrane Central databases were searched for studies comparing outcomes in DM and NDM patients who underwent LVAD implantation for advanced heart failure. Results were reported as random effect risk ratios (RR) with 95% confidence intervals. We identified 5 retrospective cohort studies, at low risk of bias, reporting on 1,351 patients (n = 488 DM). There was increased 30-day mortality (RR 1.57 [1.00, 2.47]; p = 0.05; I2 = 0%) among DM versus NDM. The DM and NDM groups did not differ significantly in terms of 1-year mortality (RR 1.15 [0.98, 1.35]; p = 0.08; I2 = 39%), device-related infection (RR 1.05 [0.92, 1.19]; p = 0.88; I2 = 0%), ischemic stroke (RR 1.29 [0.91, 1.83]; p = 0.69; I2 = 0%), hemorrhagic stroke (RR 1.10 [0.42, 2.83]; p = 0.85; I2 = 69%), or bleeding (RR 1.06 [0.80, 1.40]; p = 0.70; I2 = 27%). After LVAD implantation, patients with DM, versus patients without, have a modestly elevated 30-day mortality rate. However, 1-year mortality and morbidity did not differ.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2019.09.021</identifier><identifier>PMID: 31653350</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Bleeding ; Cause of Death ; Cohort Studies ; Confidence intervals ; Congestive heart failure ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - diagnosis ; Diabetes Mellitus - drug therapy ; Diabetes Mellitus - epidemiology ; Female ; Heart failure ; Heart Failure - diagnosis ; Heart Failure - epidemiology ; Heart Failure - surgery ; Heart-Assist Devices ; Hemorrhage ; Humans ; Hypertension ; Implantation ; Infections ; Ischemia ; Life expectancy ; Life span ; Male ; Meta-analysis ; Morbidity ; Mortality ; Prognosis ; Retrospective Studies ; Risk analysis ; Risk Assessment ; Stroke ; Survival Analysis ; Systematic review ; Thromboembolism ; Transplants & implants ; Treatment Outcome ; Ventricle</subject><ispartof>The American journal of cardiology, 2019-12, Vol.124 (12), p.1918-1923</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><rights>2019. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-618a3bbe161168603ff78d3df98308bf4142e4c38519802da19a02d298e0204c3</citedby><cites>FETCH-LOGICAL-c393t-618a3bbe161168603ff78d3df98308bf4142e4c38519802da19a02d298e0204c3</cites><orcidid>0000-0003-1559-6911 ; 0000-0002-0782-6054</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2317269390?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31653350$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lateef, Noman</creatorcontrib><creatorcontrib>Usman, Muhammad Shariq</creatorcontrib><creatorcontrib>Colombo, Paolo C.</creatorcontrib><creatorcontrib>Ahmed, Saba</creatorcontrib><creatorcontrib>Khan, Muhammad Shahzeb</creatorcontrib><creatorcontrib>Khan, Safi U.</creatorcontrib><creatorcontrib>Garan, Arthur R.</creatorcontrib><creatorcontrib>Yuzefpolskaya, Melana</creatorcontrib><creatorcontrib>Demmer, Ryan T.</creatorcontrib><title>Meta-Analysis Comparing Risk for Adverse Outcomes After Left Ventricular Assist Device Implantation in Patients With Versus Without Diabetes Mellitus</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Patients with diabetes mellitus (DM) are known to have reduced life expectancy and be at increased risk for multiple morbidities including serious infection. However, published data on DM outcomes after left ventricular assist device (LVAD) implantation are sparse, inconsistent and individual studies are small with limited power. We conducted a systematic review and meta-analysis to compare survival and adverse events post-LVAD in DM versus non-DM (NDM) patients. Medline, Scopus, and Cochrane Central databases were searched for studies comparing outcomes in DM and NDM patients who underwent LVAD implantation for advanced heart failure. Results were reported as random effect risk ratios (RR) with 95% confidence intervals. We identified 5 retrospective cohort studies, at low risk of bias, reporting on 1,351 patients (n = 488 DM). There was increased 30-day mortality (RR 1.57 [1.00, 2.47]; p = 0.05; I2 = 0%) among DM versus NDM. The DM and NDM groups did not differ significantly in terms of 1-year mortality (RR 1.15 [0.98, 1.35]; p = 0.08; I2 = 39%), device-related infection (RR 1.05 [0.92, 1.19]; p = 0.88; I2 = 0%), ischemic stroke (RR 1.29 [0.91, 1.83]; p = 0.69; I2 = 0%), hemorrhagic stroke (RR 1.10 [0.42, 2.83]; p = 0.85; I2 = 69%), or bleeding (RR 1.06 [0.80, 1.40]; p = 0.70; I2 = 27%). After LVAD implantation, patients with DM, versus patients without, have a modestly elevated 30-day mortality rate. However, 1-year mortality and morbidity did not differ.</description><subject>Bleeding</subject><subject>Cause of Death</subject><subject>Cohort Studies</subject><subject>Confidence intervals</subject><subject>Congestive heart failure</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - diagnosis</subject><subject>Diabetes Mellitus - drug therapy</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Failure - surgery</subject><subject>Heart-Assist Devices</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Implantation</subject><subject>Infections</subject><subject>Ischemia</subject><subject>Life expectancy</subject><subject>Life span</subject><subject>Male</subject><subject>Meta-analysis</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk Assessment</subject><subject>Stroke</subject><subject>Survival Analysis</subject><subject>Systematic review</subject><subject>Thromboembolism</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><subject>Ventricle</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkc-O0zAQxiMEYsvCI4AsceGS4rETNz6hqsDuSl0tQvw5Wo4zAZckLrZTaR-E92WqFg5ckEaasfz7PlvzFcVz4EvgoF7vlnbcORu7peCgl5xKwINiAc1Kl6BBPiwWnHNRaqj0RfEkpR0dAWr1uLiQoGopa74oft1ituV6ssN98oltwri30U_f2EeffrA-RLbuDhgTsrs5uzBiYus-Y2Rb7DP7glOO3s2DJS6RQWZv8eAdsptxP9gp2-zDxPzEPtBEcGJfff5Oupjm0xxm0njbYibrWxwGn-f0tHjU2yHhs3O_LD6_f_dpc11u765uNutt6aSWuVTQWNm2CApANYrLvl81nex63UjetH0FlcDKyaYG3XDRWdCWmtANcsHp4rJ4dfLdx_BzxpTN6JOjT9gJw5yMkFxXWmmtCH35D7oLc6S9HSlYCaWl5kTVJ8rFkFLE3uyjH228N8DNMTezM-fczDE3w6kEkO7F2X1uR-z-qv4ERcCbE4C0joPHaJKjhTrsfESXTRf8f574DXnhrHk</recordid><startdate>20191215</startdate><enddate>20191215</enddate><creator>Lateef, Noman</creator><creator>Usman, Muhammad Shariq</creator><creator>Colombo, Paolo C.</creator><creator>Ahmed, Saba</creator><creator>Khan, Muhammad Shahzeb</creator><creator>Khan, Safi U.</creator><creator>Garan, Arthur R.</creator><creator>Yuzefpolskaya, Melana</creator><creator>Demmer, Ryan T.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1559-6911</orcidid><orcidid>https://orcid.org/0000-0002-0782-6054</orcidid></search><sort><creationdate>20191215</creationdate><title>Meta-Analysis Comparing Risk for Adverse Outcomes After Left Ventricular Assist Device Implantation in Patients With Versus Without Diabetes Mellitus</title><author>Lateef, Noman ; Usman, Muhammad Shariq ; Colombo, Paolo C. ; Ahmed, Saba ; Khan, Muhammad Shahzeb ; Khan, Safi U. ; Garan, Arthur R. ; Yuzefpolskaya, Melana ; Demmer, Ryan T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-618a3bbe161168603ff78d3df98308bf4142e4c38519802da19a02d298e0204c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Bleeding</topic><topic>Cause of Death</topic><topic>Cohort Studies</topic><topic>Confidence intervals</topic><topic>Congestive heart failure</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus - diagnosis</topic><topic>Diabetes Mellitus - drug therapy</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Female</topic><topic>Heart failure</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Failure - surgery</topic><topic>Heart-Assist Devices</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Implantation</topic><topic>Infections</topic><topic>Ischemia</topic><topic>Life expectancy</topic><topic>Life span</topic><topic>Male</topic><topic>Meta-analysis</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk analysis</topic><topic>Risk Assessment</topic><topic>Stroke</topic><topic>Survival Analysis</topic><topic>Systematic review</topic><topic>Thromboembolism</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lateef, Noman</creatorcontrib><creatorcontrib>Usman, Muhammad Shariq</creatorcontrib><creatorcontrib>Colombo, Paolo C.</creatorcontrib><creatorcontrib>Ahmed, Saba</creatorcontrib><creatorcontrib>Khan, Muhammad Shahzeb</creatorcontrib><creatorcontrib>Khan, Safi U.</creatorcontrib><creatorcontrib>Garan, Arthur R.</creatorcontrib><creatorcontrib>Yuzefpolskaya, Melana</creatorcontrib><creatorcontrib>Demmer, Ryan T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lateef, Noman</au><au>Usman, Muhammad Shariq</au><au>Colombo, Paolo C.</au><au>Ahmed, Saba</au><au>Khan, Muhammad Shahzeb</au><au>Khan, Safi U.</au><au>Garan, Arthur R.</au><au>Yuzefpolskaya, Melana</au><au>Demmer, Ryan T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meta-Analysis Comparing Risk for Adverse Outcomes After Left Ventricular Assist Device Implantation in Patients With Versus Without Diabetes Mellitus</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2019-12-15</date><risdate>2019</risdate><volume>124</volume><issue>12</issue><spage>1918</spage><epage>1923</epage><pages>1918-1923</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>Patients with diabetes mellitus (DM) are known to have reduced life expectancy and be at increased risk for multiple morbidities including serious infection. However, published data on DM outcomes after left ventricular assist device (LVAD) implantation are sparse, inconsistent and individual studies are small with limited power. We conducted a systematic review and meta-analysis to compare survival and adverse events post-LVAD in DM versus non-DM (NDM) patients. Medline, Scopus, and Cochrane Central databases were searched for studies comparing outcomes in DM and NDM patients who underwent LVAD implantation for advanced heart failure. Results were reported as random effect risk ratios (RR) with 95% confidence intervals. We identified 5 retrospective cohort studies, at low risk of bias, reporting on 1,351 patients (n = 488 DM). There was increased 30-day mortality (RR 1.57 [1.00, 2.47]; p = 0.05; I2 = 0%) among DM versus NDM. The DM and NDM groups did not differ significantly in terms of 1-year mortality (RR 1.15 [0.98, 1.35]; p = 0.08; I2 = 39%), device-related infection (RR 1.05 [0.92, 1.19]; p = 0.88; I2 = 0%), ischemic stroke (RR 1.29 [0.91, 1.83]; p = 0.69; I2 = 0%), hemorrhagic stroke (RR 1.10 [0.42, 2.83]; p = 0.85; I2 = 69%), or bleeding (RR 1.06 [0.80, 1.40]; p = 0.70; I2 = 27%). After LVAD implantation, patients with DM, versus patients without, have a modestly elevated 30-day mortality rate. However, 1-year mortality and morbidity did not differ.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31653350</pmid><doi>10.1016/j.amjcard.2019.09.021</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-1559-6911</orcidid><orcidid>https://orcid.org/0000-0002-0782-6054</orcidid></addata></record> |
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| subjects | Bleeding Cause of Death Cohort Studies Confidence intervals Congestive heart failure Diabetes Diabetes mellitus Diabetes Mellitus - diagnosis Diabetes Mellitus - drug therapy Diabetes Mellitus - epidemiology Female Heart failure Heart Failure - diagnosis Heart Failure - epidemiology Heart Failure - surgery Heart-Assist Devices Hemorrhage Humans Hypertension Implantation Infections Ischemia Life expectancy Life span Male Meta-analysis Morbidity Mortality Prognosis Retrospective Studies Risk analysis Risk Assessment Stroke Survival Analysis Systematic review Thromboembolism Transplants & implants Treatment Outcome Ventricle |
| title | Meta-Analysis Comparing Risk for Adverse Outcomes After Left Ventricular Assist Device Implantation in Patients With Versus Without Diabetes Mellitus |
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