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Original article
Available online 8 October 2021
Changes over time in the association between type 2 diabetes and post-discharge outcomes in decompensated chronic heart failure patients: Findings from the RICA Registry
Evolución de la asociación de diabetes y eventos posalta en pacientes con insuficiencia cardíaca crónica descompensada: hallazgos del registro RICA
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F.J. Carrasco-Sáncheza,
Corresponding author
, M.I. Páez-Rubioa, J.C. Arévalo-Loridob, J. Carretero-Gómezb, A. Conde-Martelc, F. Epelded, P. Álvarez-Rochae, M.P. Salamanca-Bautistaf, J.M. Cepeda-Rodrigog, M. Montero-Pérez-Barqueroh, on behalf of the RICA Registry working group 1
a Área de Insuficiencia Cardíaca, Diabetes y Riesgo Vascular, UGC Medicina Interna y Cuidados Paliativos, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
b Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, Spain
c Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
d Unidad de Estancia Corta, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
e Unidad Multidisciplinaria de Insuficiencia Cardíaca, Medicina Interna y Cardiología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
f Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
g Servicio de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, Spain
h Servicio de Medicina Interna, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain
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Tables (4)
Table 1. Baseline characteristics of the 2018 cohort population according to diabetes and comparison to patients with diabetes from the 2008 to 2011 cohort.
Table 2. Percentage of events according to diabetes, time cohort, and glucose-lowering treatment. Events during follow-up among patients with diabetes in the 2018 cohort and 2008-2011 cohort (A). Total mortality or readmissions according to antidiabetic treatment upon discharge in the 2018 cohort (B).
Table 3. Independent predictors of mortality or hospital readmission at 12 months of follow-up in the 2018 cohort. Univariate and multivariate analyses via the Cox regression.
Table 4. Independent predictors of mortality or hospital readmission at 12 months of follow-up in patients with diabetes according to inclusion in 2008–2011 versus 2018. Multivariate analyses via the Cox regression.
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Abstract
Aims

Heart failure (HF) and diabetes are 2 strongly associated diseases. The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2 time periods.

Methods

This work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008–2011 or 2018. The patients are from the Spanish Society of Internal Medicine's National Heart Failure Registry (RICA, for its initials in Spanish). The primary endpoint was to analyze the composite outcome of total mortality and/or readmission due to HF in 12 months. A multivariate Cox regression model was used to evaluate the strength of association (hazard ratio [HR]) between diabetes and the outcomes between both periods.

Results

A total of 936 patients were included in the 2018 cohort, of which 446 (48%) had diabetes. The baseline characteristics of the populations from the 2 periods were similar. In patients with diabetes, the composite outcome was observed in 233 (47.5%) in the 2008–2011 cohort and 162 (36%) in the 2018 cohort [HR 1.48; 95% confidence interval (95%CI) 1.18–1.85; p < .001]. The proportion of readmissions (HR 1.39; 95%CI 1.07–1.80; p = .015) and total mortality (HR 1.60; 95%CI 1.20–2.14; p < .001) were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort.

Conclusions

In 2018, an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008–2011 period.

Keywords:
Diabetes mellitus
Heart failure
Mortality
Hospitalization
Readmissions
Prognosis
Resumen
Objetivos

La insuficiencia cardíaca (IC) y la diabetes son 2 procesos fuertemente asociados. El objetivo principal fue analizar la evolución del pronóstico de los pacientes con diabetes que ingresan por IC a lo largo de 2 períodos.

Métodos

Estudio prospectivo para comparar el pronóstico a un año de seguimiento entre los pacientes con diabetes que ingresan por IC en 2008–2011 y 2018. Los pacientes proceden del Registro Nacional de Insuficiencia Cardíaca (RICA) de la Sociedad Española de Medicina Interna. El objetivo primario fue analizar el desenlace combinado de mortalidad total o ingreso por IC durante 12 meses. Se utilizó una regresión multivariante de Cox para evaluar la fuerza de asociación (hazard ratio [HR]) de la diabetes y los desenlaces entre ambos períodos.

Resultados

Se incluyó a un total de 936 pacientes en la cohorte de 2018, de los que 446 (48%) tenían diabetes. Las características basales de la población de los 2 períodos fueron similares. En los pacientes con diabetes se observó el desenlace combinado en 233 (47,5%) en la cohorte de 2008−2011 y 162 (36%) en la cohorte de 2018 (HR 1,48; intervalo de confianza del 95% [IC95%] 1,18–1,85; p < 0,001). La proporción de ingresos (HR 1,39; IC95% 1,07–1,80; p = 0,015) y la mortalidad total (HR 1,60; IC95% 1,20–2,14; p < 0,001) también fueron significativamente mayores en los pacientes con diabetes de la cohorte de 2008–2011 con respecto a la del 2018.

Conclusiones

En 2018 se observa una mejoría del pronóstico de la mortalidad total y los reingresos durante un año de seguimiento en pacientes con diabetes hospitalizados por IC con respecto al período de 2008–2011.

Palabras clave:
Diabetes mellitus
Insuficiencia cardíaca
Mortalidad
Hospitalización
Reingresos
Pronóstico

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