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Association Between Diabetes Mellitus and Post-Discharge Outcomes in Patients Hospitalized with Heart Failure: Findings from the EVEREST Trial
Open accessAbstract
AIMS: We evaluated the impact of diabetes mellitus (DM) and diabetic therapy on outcomes in patients with reduced ejection fraction (EF) after hospitalization for heart failure (HF). DM is prevalent in patients hospitalized with HF, yet inconclusive data exist on the post-discharge outcomes of this patient population. METHODS AND RESULTS: Post-hoc analysis was performed on the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan) study, a randomized trial of patients hospitalized with HF (n = 4133) with median follow-up of 9.9 months. DM status was determined from intake questionnaires and cross-verified by medication history. Univariate relationships were examined using χ(2) test, t-test, and Wilcoxon tests. The two primary outcomes of (i) all-cause mortality (ACM) and (ii) cardiovascular mortality or HF hospitalization (CVM + HFH) were assessed for those with and without DM and by diabetic treatment strategy using log rank tests and multivariable Cox regression models. DM was present in 40% of participants. Patients with DM were more likely to have hypertension, coronary artery disease, and chronic kidney disease. Diabetes was associated with ACM and CVM + HFH (both P < 0.001). Following multivariate risk adjustment, DM was associated with ACM, but this estimate was imprecise [hazard ratio (HR) 1.16; 95% confidence interval (CI) 1.00-1.34] and remained associated with CVM or HFH (HR 1.17; 95% CI 1.04-1.31). Diabetic control strategy did not independently affect outcomes. CONCLUSION: Diabetes is common in patients hospitalized for heart failure with a reduced EF. These patients have a higher post-discharge CVM and higher HF hospitalizations compared with patients with no diabetes. Different diabetic treatment regimens did not appear to influence post-discharge outcomes.
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“For example, in the EVEREST trial in which patients were followed for 9.9 months after a HF hospitalization, T2DM conferred a slightly higher mortality.45”
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 [45]
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“However, with longer-term follow-up, an association between T2DM and worse outcomes in HF patients becomes evident.”
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 [45]
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Metadata
- Authors
- Sarma, S., Mentz, R. J., Kwasny, M. J., Fought, A. J., Huffman, M., Subacius, H., Nodari, S., Konstam, M., Swedberg, K., Maggioni, A. P., Zannad, F., Bonow, R. O., & Gheorghiade, M.
- Affiliations
- Northwestern University (US)
- Duke University (US)
- University of Brescia (IT)
- Tufts University (US)
- University of Gothenburg (SE)
- Associazione Nazionale Medici Cardiologi Ospedalieri (IT)
- Department of Cardiology, Nancy University , Nancy ,
- Corresponding author
- Gheorghiade, Mihai
- ORCID
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-02-01
- Volume
- 15
- Issue
- 2
- Pages
- 194-202
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- PMC
- PMC4176083
- OpenAlex
- W2085741095
- Cited by
- 202
- References
- 33
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 27 · 2023: 11 · 2022: 11 · 2021: 16 · 2020: 23 · 2019: 8 · 2018: 29 · 2017: 17 · 2016: 18 · 2015: 15 · 2014: 11 · 2013: 8
- FWCI
- 6.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion, public-domain)
- Funders
- Northwestern University
- Feinberg School of Medicine
- National Institute of General Medical Sciences (T32GM086330)
- 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
- diabetes mellitus, heart failure, reduced ejection fraction, post-discharge outcomes, all-cause mortality, cardiovascular mortality, heart failure hospitalization, EVEREST trial, tolvaptan, vasopressin receptor antagonism, comorbidities
- MeSH terms
- Tolvaptan, Adult, Aged, Aged, 80 and over, Benzazepines, Cause of Death, Combined Modality Therapy, Cross-Sectional Studies, Diet, Diabetic, Female, Follow-Up Studies, Hospitalization, Humans, Hypoglycemic Agents, Insulin, Male, Middle Aged, Patient Discharge, Comorbidity, Proportional Hazards Models, Treatment Outcome, Disease Progression, Diabetes Complications, Heart Failure, Systolic, Antidiuretic Hormone Receptor Antagonists
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