Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database
The prognostic role of diabetes mellitus (DM) in heart failure (HF) patients is undefined, since DM is outweighed by several DM-related variables when confounders are considered. We determined the prognostic role of DM, treatment, and glycemic control in a real-life HF population. 3927 HF patients i...
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| Veröffentlicht in: | International journal of cardiology 2020-10, Vol.317, p.103-110 |
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| creator | Paolillo, Stefania Salvioni, Elisabetta Perrone Filardi, Pasquale Bonomi, Alice Sinagra, Gianfranco Gentile, Piero Gargiulo, Paola Scoccia, Alessandra Cosentino, Nicola Gugliandolo, Paola Badagliacca, Roberto Lagioia, Rocco Correale, Michele Frigerio, Maria Perna, Enrico Piepoli, Massimo Re, Federica Raimondo, Rosa Minà, Chiara Clemenza, Francesco Bussotti, Maurizio Limongelli, Giuseppe Gravino, Rita Passantino, Andrea Magrì, Damiano Parati, Gianfranco Caravita, Sergio Scardovi, Angela B Arcari, Luca Vignati, Carlo Mapelli, Massimo Cattadori, Gaia Cavaliere, Carlo Corrà, Ugo Agostoni, Piergiuseppe |
| description | The prognostic role of diabetes mellitus (DM) in heart failure (HF) patients is undefined, since DM is outweighed by several DM-related variables when confounders are considered. We determined the prognostic role of DM, treatment, and glycemic control in a real-life HF population.
3927 HF patients included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score database were evaluated with a median follow-up of 3.66 years (IQR 1.70-6.67). Data analysis considered survival between DM (n = 897) vs. non-DM (n = 3030) patients, and, in diabetics, between insulin (n = 304), oral antidiabetics (n = 479), and dietary only (n = 88) treatments. The role of glycemic control was evaluated grouping DM patients according to glycated hemoglobin (HbA1c): 8% (n = 149). All analyses were performed also adjusting for ejection fraction, renal function, hemoglobin, sodium, exercise peak oxygen uptake, and ventilation/carbon dioxide relationship slope. Study primary endpoint was the composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Secondary endpoints were cardiovascular and all causes death.
For all endpoints, upon adjustment for confounders, DM status and insulin treatment or dietary regimen were not significantly associated with adverse long-term prognosis compared to non-DM and oral antidiabetic treated patients, respectively. A worse prognosis was observed in HbA1c >8% patients (Log-Rank p |
| doi_str_mv | 10.1016/j.ijcard.2020.04.079 |
| format | Article |
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3927 HF patients included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score database were evaluated with a median follow-up of 3.66 years (IQR 1.70-6.67). Data analysis considered survival between DM (n = 897) vs. non-DM (n = 3030) patients, and, in diabetics, between insulin (n = 304), oral antidiabetics (n = 479), and dietary only (n = 88) treatments. The role of glycemic control was evaluated grouping DM patients according to glycated hemoglobin (HbA1c): <7% (n = 266), 7.1-8% (n = 133), >8% (n = 149). All analyses were performed also adjusting for ejection fraction, renal function, hemoglobin, sodium, exercise peak oxygen uptake, and ventilation/carbon dioxide relationship slope. Study primary endpoint was the composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Secondary endpoints were cardiovascular and all causes death.
For all endpoints, upon adjustment for confounders, DM status and insulin treatment or dietary regimen were not significantly associated with adverse long-term prognosis compared to non-DM and oral antidiabetic treated patients, respectively. A worse prognosis was observed in HbA1c >8% patients (Log-Rank p < 0.001), even after correction for confounding factors. All results were replicated by hazard ratio analysis.
In HF patients, DM, insulin treatment and dietary regimen are not adverse outcome predictors. The only condition related to long-term prognosis, considering potential confounders, is poor glycemic control.</description><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2020.04.079</identifier><identifier>PMID: 32360652</identifier><language>eng</language><publisher>Netherlands</publisher><subject>Diabetes Mellitus - diagnosis ; Diabetes Mellitus - drug therapy ; Diabetes Mellitus - epidemiology ; Glycemic Control ; Heart Failure - diagnosis ; Heart Failure - drug therapy ; Heart Failure - epidemiology ; Humans ; Kidney ; Prognosis ; Stroke Volume</subject><ispartof>International journal of cardiology, 2020-10, Vol.317, p.103-110</ispartof><rights>Copyright © 2020 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32360652$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Paolillo, Stefania</creatorcontrib><creatorcontrib>Salvioni, Elisabetta</creatorcontrib><creatorcontrib>Perrone Filardi, Pasquale</creatorcontrib><creatorcontrib>Bonomi, Alice</creatorcontrib><creatorcontrib>Sinagra, Gianfranco</creatorcontrib><creatorcontrib>Gentile, Piero</creatorcontrib><creatorcontrib>Gargiulo, Paola</creatorcontrib><creatorcontrib>Scoccia, Alessandra</creatorcontrib><creatorcontrib>Cosentino, Nicola</creatorcontrib><creatorcontrib>Gugliandolo, Paola</creatorcontrib><creatorcontrib>Badagliacca, Roberto</creatorcontrib><creatorcontrib>Lagioia, Rocco</creatorcontrib><creatorcontrib>Correale, Michele</creatorcontrib><creatorcontrib>Frigerio, Maria</creatorcontrib><creatorcontrib>Perna, Enrico</creatorcontrib><creatorcontrib>Piepoli, Massimo</creatorcontrib><creatorcontrib>Re, Federica</creatorcontrib><creatorcontrib>Raimondo, Rosa</creatorcontrib><creatorcontrib>Minà, Chiara</creatorcontrib><creatorcontrib>Clemenza, Francesco</creatorcontrib><creatorcontrib>Bussotti, Maurizio</creatorcontrib><creatorcontrib>Limongelli, Giuseppe</creatorcontrib><creatorcontrib>Gravino, Rita</creatorcontrib><creatorcontrib>Passantino, Andrea</creatorcontrib><creatorcontrib>Magrì, Damiano</creatorcontrib><creatorcontrib>Parati, Gianfranco</creatorcontrib><creatorcontrib>Caravita, Sergio</creatorcontrib><creatorcontrib>Scardovi, Angela B</creatorcontrib><creatorcontrib>Arcari, Luca</creatorcontrib><creatorcontrib>Vignati, Carlo</creatorcontrib><creatorcontrib>Mapelli, Massimo</creatorcontrib><creatorcontrib>Cattadori, Gaia</creatorcontrib><creatorcontrib>Cavaliere, Carlo</creatorcontrib><creatorcontrib>Corrà, Ugo</creatorcontrib><creatorcontrib>Agostoni, Piergiuseppe</creatorcontrib><creatorcontrib>MECKI score research group (see Appendix A)</creatorcontrib><title>Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>The prognostic role of diabetes mellitus (DM) in heart failure (HF) patients is undefined, since DM is outweighed by several DM-related variables when confounders are considered. We determined the prognostic role of DM, treatment, and glycemic control in a real-life HF population.
3927 HF patients included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score database were evaluated with a median follow-up of 3.66 years (IQR 1.70-6.67). Data analysis considered survival between DM (n = 897) vs. non-DM (n = 3030) patients, and, in diabetics, between insulin (n = 304), oral antidiabetics (n = 479), and dietary only (n = 88) treatments. The role of glycemic control was evaluated grouping DM patients according to glycated hemoglobin (HbA1c): <7% (n = 266), 7.1-8% (n = 133), >8% (n = 149). All analyses were performed also adjusting for ejection fraction, renal function, hemoglobin, sodium, exercise peak oxygen uptake, and ventilation/carbon dioxide relationship slope. Study primary endpoint was the composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Secondary endpoints were cardiovascular and all causes death.
For all endpoints, upon adjustment for confounders, DM status and insulin treatment or dietary regimen were not significantly associated with adverse long-term prognosis compared to non-DM and oral antidiabetic treated patients, respectively. A worse prognosis was observed in HbA1c >8% patients (Log-Rank p < 0.001), even after correction for confounding factors. All results were replicated by hazard ratio analysis.
In HF patients, DM, insulin treatment and dietary regimen are not adverse outcome predictors. The only condition related to long-term prognosis, considering potential confounders, is poor glycemic control.</description><subject>Diabetes Mellitus - diagnosis</subject><subject>Diabetes Mellitus - drug therapy</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Glycemic Control</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - epidemiology</subject><subject>Humans</subject><subject>Kidney</subject><subject>Prognosis</subject><subject>Stroke Volume</subject><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo10MFq3DAUBVBRKJ1pkj8o4S2zsSvJsmx1F4akHTqliybrQZaeZjTY0lSSCfmffGhMmq7eWxwu3EvIF0ZrRpn8eqr9yehka045ramoaac-kDXrO1GxrhUr8jnnE6VUKNV_IquGN5LKlq_Jyy6GQ1UwTXBO8RBiLt5AiiNCdGC9HrBghgnH0Zc5gw4WDuOzwWlhJoayUPABjqhTAaf9OCeEsy4eQ8nw5MsREtrZoAU8oSk-BnBJvz3fYBuyPxwX6FKcoBwRft1tfm7hj4lLjNVFDzrjJfno9Jjx6v1ekMf7u4fNj2r3-_t2c7urzpyxUnGJXe-YVpIyOxhLFVIz9FYM3LQtRamk6x1VTHLJRc86NqBoUQyu7ZBR1VyQm3-5yxR_Z8xlP_lsluo6YJzznjeqZ61gjVjo9Tudhwnt_pz8pNPz_v-yzSuoUH2k</recordid><startdate>20201015</startdate><enddate>20201015</enddate><creator>Paolillo, Stefania</creator><creator>Salvioni, Elisabetta</creator><creator>Perrone Filardi, Pasquale</creator><creator>Bonomi, Alice</creator><creator>Sinagra, Gianfranco</creator><creator>Gentile, Piero</creator><creator>Gargiulo, Paola</creator><creator>Scoccia, Alessandra</creator><creator>Cosentino, Nicola</creator><creator>Gugliandolo, Paola</creator><creator>Badagliacca, Roberto</creator><creator>Lagioia, Rocco</creator><creator>Correale, Michele</creator><creator>Frigerio, Maria</creator><creator>Perna, Enrico</creator><creator>Piepoli, Massimo</creator><creator>Re, Federica</creator><creator>Raimondo, Rosa</creator><creator>Minà, Chiara</creator><creator>Clemenza, Francesco</creator><creator>Bussotti, Maurizio</creator><creator>Limongelli, Giuseppe</creator><creator>Gravino, Rita</creator><creator>Passantino, Andrea</creator><creator>Magrì, Damiano</creator><creator>Parati, Gianfranco</creator><creator>Caravita, Sergio</creator><creator>Scardovi, Angela B</creator><creator>Arcari, Luca</creator><creator>Vignati, Carlo</creator><creator>Mapelli, Massimo</creator><creator>Cattadori, Gaia</creator><creator>Cavaliere, Carlo</creator><creator>Corrà, Ugo</creator><creator>Agostoni, Piergiuseppe</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20201015</creationdate><title>Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database</title><author>Paolillo, Stefania ; Salvioni, Elisabetta ; Perrone Filardi, Pasquale ; Bonomi, Alice ; Sinagra, Gianfranco ; Gentile, Piero ; Gargiulo, Paola ; Scoccia, Alessandra ; Cosentino, Nicola ; Gugliandolo, Paola ; Badagliacca, Roberto ; Lagioia, Rocco ; Correale, Michele ; Frigerio, Maria ; Perna, Enrico ; Piepoli, Massimo ; Re, Federica ; Raimondo, Rosa ; Minà, Chiara ; Clemenza, Francesco ; Bussotti, Maurizio ; Limongelli, Giuseppe ; Gravino, Rita ; Passantino, Andrea ; Magrì, Damiano ; Parati, Gianfranco ; Caravita, Sergio ; Scardovi, Angela B ; Arcari, Luca ; Vignati, Carlo ; Mapelli, Massimo ; Cattadori, Gaia ; Cavaliere, Carlo ; Corrà, Ugo ; Agostoni, Piergiuseppe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p211t-26e78f1a9601dbcd09e0cb8d4b2c550e696f8f091626248171be45e4bf57e1093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Diabetes Mellitus - 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Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Paolillo, Stefania</au><au>Salvioni, Elisabetta</au><au>Perrone Filardi, Pasquale</au><au>Bonomi, Alice</au><au>Sinagra, Gianfranco</au><au>Gentile, Piero</au><au>Gargiulo, Paola</au><au>Scoccia, Alessandra</au><au>Cosentino, Nicola</au><au>Gugliandolo, Paola</au><au>Badagliacca, Roberto</au><au>Lagioia, Rocco</au><au>Correale, Michele</au><au>Frigerio, Maria</au><au>Perna, Enrico</au><au>Piepoli, Massimo</au><au>Re, Federica</au><au>Raimondo, Rosa</au><au>Minà, Chiara</au><au>Clemenza, Francesco</au><au>Bussotti, Maurizio</au><au>Limongelli, Giuseppe</au><au>Gravino, Rita</au><au>Passantino, Andrea</au><au>Magrì, Damiano</au><au>Parati, Gianfranco</au><au>Caravita, Sergio</au><au>Scardovi, Angela B</au><au>Arcari, Luca</au><au>Vignati, Carlo</au><au>Mapelli, Massimo</au><au>Cattadori, Gaia</au><au>Cavaliere, Carlo</au><au>Corrà, Ugo</au><au>Agostoni, Piergiuseppe</au><aucorp>MECKI score research group (see Appendix A)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2020-10-15</date><risdate>2020</risdate><volume>317</volume><spage>103</spage><epage>110</epage><pages>103-110</pages><eissn>1874-1754</eissn><abstract>The prognostic role of diabetes mellitus (DM) in heart failure (HF) patients is undefined, since DM is outweighed by several DM-related variables when confounders are considered. We determined the prognostic role of DM, treatment, and glycemic control in a real-life HF population.
3927 HF patients included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score database were evaluated with a median follow-up of 3.66 years (IQR 1.70-6.67). Data analysis considered survival between DM (n = 897) vs. non-DM (n = 3030) patients, and, in diabetics, between insulin (n = 304), oral antidiabetics (n = 479), and dietary only (n = 88) treatments. The role of glycemic control was evaluated grouping DM patients according to glycated hemoglobin (HbA1c): <7% (n = 266), 7.1-8% (n = 133), >8% (n = 149). All analyses were performed also adjusting for ejection fraction, renal function, hemoglobin, sodium, exercise peak oxygen uptake, and ventilation/carbon dioxide relationship slope. Study primary endpoint was the composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Secondary endpoints were cardiovascular and all causes death.
For all endpoints, upon adjustment for confounders, DM status and insulin treatment or dietary regimen were not significantly associated with adverse long-term prognosis compared to non-DM and oral antidiabetic treated patients, respectively. A worse prognosis was observed in HbA1c >8% patients (Log-Rank p < 0.001), even after correction for confounding factors. All results were replicated by hazard ratio analysis.
In HF patients, DM, insulin treatment and dietary regimen are not adverse outcome predictors. The only condition related to long-term prognosis, considering potential confounders, is poor glycemic control.</abstract><cop>Netherlands</cop><pmid>32360652</pmid><doi>10.1016/j.ijcard.2020.04.079</doi><tpages>8</tpages></addata></record> |
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| ispartof | International journal of cardiology, 2020-10, Vol.317, p.103-110 |
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| language | eng |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Diabetes Mellitus - diagnosis Diabetes Mellitus - drug therapy Diabetes Mellitus - epidemiology Glycemic Control Heart Failure - diagnosis Heart Failure - drug therapy Heart Failure - epidemiology Humans Kidney Prognosis Stroke Volume |
| title | Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database |
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