Discordant Short- and Long-Term Outcomes Associated With Diabetes in Patients With Heart Failure: Importance of Age and Sex: A Population Study of 5.1 Million People in Scotland
Abstract
BACKGROUND: Diabetes and heart failure frequently coexist. Our aim was to assess the association between diabetes and short- and long-term outcomes in all patients admitted to the hospital for the first time with heart failure in Scotland between 1986 and 2003. METHODS AND RESULTS: A total of 116 556 patients were studied, of whom 13% (n=15 161) had a diagnosis of diabetes. At 30 days, diabetes was associated with a lower case fatality. By 1 year, the association between diabetes and better outcome was reversed, and diabetes was a significant independent predictor of higher case fatality. The longer term risk of death associated with diabetes was greatest in younger patients. In patients aged 65 years or younger, the hazard ratio for mortality at 5 years associated with diabetes was 1.41 (95% CI, 1.31 to 1.52) for men and 1.64 (1.50 to 1.79) for women. The risk associated with diabetes was less in patients aged 75 years or older: a hazard ratio in men 1.16 (1.10 to 1.22) and in women 1.15 (1.10 to 1.20). In the younger age group the risk associated with diabetes was significantly greater in women than in men (P=0.005 for diabetes-sex interaction). Diabetes was also a significant independent predictor of heart failure readmission, and again the risk was greatest in younger women. CONCLUSIONS: Although diabetes was associated with a lower case fatality at 30 days, by 1 year it was a significant independent predictor of higher case fatality. The risk associated with diabetes was greatest in young patients, and in young patients the risk was greatest in women.
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With longer-term follow-up, an association between T2DM and worse outcomes in HF patients becomes evident.
“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 [87]
There is a suggestion from some cohorts that short-term mortality in HF patients post-discharge may be similar or slightly lower in those with T2DM.
“There is a suggestion from some cohorts 82,87 that short-term mortality in HF patients post-discharge may be similar or slightly lower in those with T2DM.”
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 [87]
In patients from Scotland, T2DM increased mid-to-long-term mortality following hospitalization for HF.
“Also, in patients from Scotland, T2DM increased mid-to-long-term mortality following hospitalization for HF. 87”
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 [87]
In two population-based studies from Scotland and Sweden, the increased mortality risk of T2DM was seen in both women and men, but the effect was slightly greater in women.
“In two population-based studies from Scotland and Sweden, the increased mortality risk of T2DM was seen in both women and men, but the effect was slightly greater in women.87,96”
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 [87]
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- Authors
- MacDonald, M. R., Jhund, P. S., Petrie, M. C., Lewsey, J. D., Hawkins, N. M., Bhagra, S., Munoz, N., Varyani, F., Redpath, A., Chalmers, J., MacIntyre, K., & McMurray, J. J. V.
- Affiliations
- National Health Service Scotland (GB)
- From the Advanced Heart Failure Service (M.R.M., M.C.P., S.B.), Golden Jubilee National Hospital, Glasgow, United Kingdom; BHF Glasgow Cardiovascular Research Centre (P.S.J., J.J.V.M.), Faculty of Medicine, University of Glasgow, United Kingdom; Department of Public Health and Health Policy (P.S.J., J.D.L., K.M.), Faculty of Medicine, University of Glasgow, United Kingdom; Aintree Cardiac Centre (N.M.H.), Liverpool, United Kingdom; Hospital Infanta Leonor (N.M.), Madrid, Spain; Lincoln County...
- ORCID
- Venue
- Circulation Heart Failure
- Published
- 2008-11
- Volume
- 1
- Issue
- 4
- Pages
- 234-241
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- OpenAlex
- W2110092749
- Cited by
- 64
- References
- 24
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 4 · 2020: 7 · 2019: 1 · 2018: 11 · 2017: 7 · 2016: 4 · 2015: 6 · 2014: 3 · 2013: 1 · 2012: 3
- FWCI
- 1.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- eCite Digital Repository (University of Tasmania) (submittedVersion)
- Figshare (submittedVersion)
- 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, Cardiovascular Risks, and Lipoproteins
- Keywords
- diabetes mellitus, heart failure, case fatality, mortality, heart failure readmission, age differences, sex differences, young women, hospitalization
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Diabetes Mellitus, Female, Heart Failure, Humans, Male, Middle Aged, Patient Readmission, Scotland, Sex Factors, Time Factors, Prevalence, Treatment Outcome, Risk Assessment, Diabetes Complications, Kaplan-Meier Estimate
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