Acute heart failure in patients with diabetes mellitus: Clinical characteristics and predictors of in-hospital mortality
Introduction
Heart failure (HF) and diabetes mellitus (DM) are both common clinical entities that frequently coexist in the same patient population. The prevalence of diabetes ranges from 4 to 7% in the general population, whilst reaches 11–47% in patients with heart failure, according to several clinical studies [1], [2], [3], [4], [5], [6], [7]. Despite the increased incidence of this comorbidity in HF patients, data regarding clinical profile and prognosis of this subgroup are still inadequate. Most clinical trials have demonstrated a worse outcome, established mainly in patients with left ventricular systolic dysfunction [1], [8], [9], [10], [11], [12]. However, the increased morbidity and mortality, related to diabetes, may be also attributed to other comorbidities observed in this HF patient population, such as renal dysfunction and anemia, which on the other hand may be owing to DM [13]. Additionally, clinical and prognostic interactions between diabetes and HF should be further studied in patients with preserved ejection fraction (EF) [14].
Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF) is an international registry that included patients hospitalized for acute heart failure (AHF) [15], [16]. Distinct clinical presentations, management strategies, and outcomes of AHF were described and compared in order to evaluate the utility of European Society of Cardiology (ESC) guidelines in clinical practice [17]. Our analysis aims to identify the clinical profile, treatment strategies and in-hospital mortality of acute heart failure (AHF) patients with diabetes mellitus that were enrolled in the ALARM-HF registry. Moreover, the identification of predictors of in-hospital mortality in this subgroup may promote further monitoring and possible interventions in diabetic patients that have some of these predictors at baseline. This kind of analysis has not previously been described, to the best of our knowledge.
Section snippets
Methods
ALARM-HF is a retrospective observational survey of hospitalized patients for AHF in 9 countries (6 European, Turkey, Mexico and Australia) [15]. The 4953 enrolled patients were admitted to either Cardiology Departments (67%) or Intensive Care Units (ICU) (33%) of 666 representative hospitals according to geographic region, hospital sector (public versus private), type (academic versus non-teaching status) and magnitude (by number of beds). The increased rate of ICU admissions (1/3 of the total
Results
The overall population of patients with AHF included in the ALARM-HF registry has already been classified and presented along with data concerning clinical characteristics, treatment, and outcomes [15], [18], [19]. This population consisted of 4953 patients hospitalized for AHF in nine countries (700 in Spain, 679 in Italy, 623 in UK, 628 in Turkey, 617 in Germany, 601 in Mexico, 588 in France, 255 in Greece, and 262 in Australia) in Europe, Latin America, and Australia among October 2006 and
Discussion
Diabetes mellitus is a common comorbid condition of HF patients with prevalence that varies from 6 to 25% in subjects with left ventricular systolic dysfunction, 12–30% in those with symptomatic HF, and up to 40% in patients hospitalized with HF [2], [5], [6], [7], [13], [20], [21]. This retrospective sub-analysis of the ALARM-HF survey demonstrates that 45% of hospitalized patients with AHF had history of diabetes mellitus. Similar prevalence has been reported in the Acute Decompensated Heart
Conflicts of interest statements for all authors
JP, AM, JD, FVB, and FF reported being consultant for and received research grants from Abbott, Chicago, IL, USA.
Acknowledgment
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [48].
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