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Cited by 50Cardiac pacing and defibrillation studiesHeart Failure Treatment and ManagementCardiac Arrest and Resuscitation

Influence of diabetes on cardiac resynchronization therapy with or without defibrillator in patients with advanced heart failure

Ghali, Jalal k., Boehmer, John, Feldman, Arthur M., Saxon, Leslie A., Demarco, Teresa, Carson, Peter, Yong, Patrick, Galle, Elizabeth G. +3 more·2007·Journal of Cardiac Failure
DOI 10.1016/j.cardfail.2007.06.723
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Abstract

Objectives We performed a post hoc analysis to determine the influence of cardiac resynchronization therapy with a defibrillator (CRT-D) or without a defibrillator (CRT-P) on outcomes among diabetic patients with advanced heart failure (HF).Background In patients with systolic HF, diabetes is an independent predictor of morbidity and mortality. No data are available on its impact on CRT-D or CRT-P in advanced HF.Methods The database of the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure trial was examined to determine the influence of CRT (CRT-D and CRT-P) on outcomes among diabetic patients. All-cause mortality or hospitalization, all-cause mortality or cardiovascular hospitalization, all-cause mortality or HF hospitalization, and all-cause mortality were analyzed among diabetic patients (n = 622). A Cox proportional hazard model, adjusting for age, gender, New York Heart Association, ischemic status, body mass index, left ventricular ejection fraction, heart rate, QRS, left or right bundle branch block, blood pressure, comorbidities (renal failure, carotid artery disease, peripheral vascular disease, hypertension, coronary artery bypass grafting, and atrial fibrillation), medications, and device (with or without defibrillator), was used to estimate hazard ratios (HRs) and significance.Results The overall outcome of diabetic patients was similar to that of nondiabetic patients in the optimal pharmacologic therapy arm. With CRT, diabetic patients experienced a substantial reduction in all-cause mortality or all-cause hospitalization (HR = 0.77, 95% confidence interval [CI] 62-0.97), all-cause mortality or cardiovascular hospitalization (HR = 0.67, 95% CI 0.53-0.85), all-cause mortality or HF hospitalization (HR = 0.52, 95% CI 0.40-0.69), and all-cause mortality (HR = 0.67, 95% CI 0.45-0.99) compared with optimal pharmacologic therapy. Procedure-related complications and length of stay were identical in diabetic and nondiabetic patients.Conclusion In diabetic patients with advanced HF, there is a substantial benefit from device therapy with significant improvement in all end points.

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Authors
Ghali, J. K., Boehmer, J., Feldman, A. M., Saxon, L. A., Demarco, T., Carson, P., Yong, P., Galle, E. G., Leigh, J., Ecklund, F. L., & Bristow, M. R.
Affiliations
  • Wayne State University (US)
  • Penn State Milton S. Hershey Medical Center (US)
  • Thomas Jefferson University (US)
  • University of Southern California (US)
  • University of California, San Francisco (US)
  • Veterans Health Administration (US)
  • Boston Scientific (United States) (US)
  • University of Colorado Denver (US)
Corresponding author
Ghali, Jalal k.
ORCID
Venue
Journal of Cardiac Failure
Publisher
Elsevier BV
Published
2007-11
Volume
13
Issue
9
Pages
769-773
ISSN
1071-9164 (ISSN-L)
DOI
10.1016/j.cardfail.2007.06.723
OpenAlex
W2090268656
Cited by
50
References
25
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 5 · 2021: 2 · 2020: 5 · 2019: 4 · 2018: 4 · 2016: 2 · 2015: 5 · 2014: 1 · 2013: 2 · 2012: 4
FWCI
1.64
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Cardiac Failure (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
Keywords
diabetes mellitus, cardiac resynchronization therapy, CRT-D, CRT-P, advanced heart failure, all-cause mortality, hospitalization, device therapy, heart failure hospitalization, cardiovascular hospitalization
MeSH terms
Aged, Cardiac Pacing, Artificial, Diabetes Mellitus, Diastole, Female, Health Status, Health Status Indicators, Heart Conduction System, Heart Failure, Hospitalization, Humans, Male, Retrospective Studies, Stroke Volume, Systole, Body Mass Index, Treatment Outcome, Defibrillators, Implantable

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