Acute heart failure in patients with diabetes mellitus: clinical characteristics and predictors of in-hospital mortality
Abstract
Objective/methods ALARM-HF was an in-hospital observational survey that included 4953 patients admitted for acute heart failure (AHF) in six European countries, Mexico and Australia. This article is a secondary analysis of the survey which evaluates differences in clinical phenotype, treatment regimens and in-hospital outcomes in AHF patients with diabetes mellitus (DM) compared to non-diabetics. The data were collected retrospectively by the investigators, and the diagnosis of AHF (reported at discharge) was based on the definition and classification of ESC guidelines, while the diagnosis of DM was based on medical record (past medical and medication history).Results This sub-analysis demonstrates substantial differences regarding both baseline features and in-hospital outcome among diabetic and non-diabetic AHF patients. Diabetic patients (n=2229, 45%) presented more frequently with acute pulmonary edema (p<0.001) than non-diabetics, had more often acute coronary syndrome (p<0.001) as precipitating factors of AHF, and multiple comorbidities such as renal dysfunction (p<0.001), arterial hypertension (p<0.001), anemia (p<0.001) and peripheral vascular disease (p<0.001). All-cause in-hospital mortality of diabetics was higher compared to non-diabetics (11.7% vs 9.8%, p=0.01). The multivariate analysis revealed that older age (p=0.032), systolic blood pressure <100mm Hg (p<0.001), acute coronary syndrome and non compliance as precipitating factors (p=0.05 and p=0.005, respectively), history of arterial hypertension (p=0.022), LVEF<50% (p<0.001), serum creatinine >1.5mg/dl (p=0.029), absence of life saving therapies such as ACE inhibitors/ARBs (p<0.001) and beta-blockers (p=0.014) at admission, as well as absence of interventional treatment by PCI (p<0.001), were independently associated with adverse in-hospital outcome.Conclusion Diabetics with AHF have higher in-hospital mortality than non-diabetics despite their intensive treatment regimens (regarding care for HF and ACS), possibly due to underlying ischemic heart disease and the presence of multiple comorbidities.
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In the ALARM registry and the ESC HF Long-Term Registry, T2DM was independently associated with a higher risk of in-hospital mortality.
“Conversely, in the ALARM registry (six European countries, Mexico and Australia), and in the European Society of Cardiology (ESC) HF Long-Term Registry, T2DM was independently associated with a higher risk of in-hospital mortality.51,86”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [86]
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- Authors
- Parissis, J. T., Rafouli-Stergiou, P., Mebazaa, A., Ikonomidis, I., Bistola, V., Nikolaou, M., Meas, T., Delgado, J., Vilas-Boas, F., Paraskevaidis, I., Anastasiou-Nana, M., & Follath, F.
- Affiliations
- University General Hospital Attikon (GR)
- Inserm (FR)
- Corresponding author
- Parissis, John T.
- ORCID
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-05
- Volume
- 157
- Issue
- 1
- Pages
- 108-113
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W2157370753
- Cited by
- 58
- References
- 51
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 6 · 2020: 4 · 2018: 3 · 2017: 4 · 2016: 4 · 2015: 5 · 2014: 10 · 2013: 5 · 2012: 5
- FWCI
- 4.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- acute heart failure, diabetes mellitus, in-hospital mortality, acute coronary syndrome, pulmonary edema, comorbidities, hypertension, renal dysfunction, ACE inhibitors, beta-blockers, percutaneous coronary intervention, risk factors, treatment non-adherence, left ventricular ejection fraction, serum creatinine, age, systolic blood pressure, anemia
- MeSH terms
- Acute Disease, Aged, Aged, 80 and over, Diabetes Mellitus, Female, Heart Failure, Humans, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Survival Rate, Hospital Mortality
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