Association between diabetes and 1-year adverse clinical outcomes in a multinational cohort of ambulatory patients with chronic heart failure: results from the ESC-HFA heart failure long-term registry
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OBJECTIVE: Diabetes mellitus is associated with an increased risk of cardiovascular disease (CVD) and death. Because the prevalence of diabetes is rising worldwide and chronic heart failure (CHF) is becoming increasingly common with the aging population, it is timely to examine the impact of diabetes per se on 1-year adverse outcomes in patients with CHF. RESEARCH DESIGN AND METHODS: We prospectively assessed whether diabetes status independently affected the 1-year risk of all-cause and CVD mortality and first hospitalization for worsening heart failure (HF) in a multinational cohort of 9,428 outpatients with CHF enrolled in the European Society of Cardiology and Heart Failure Association Long-Term Registry. RESULTS: Compared with those patients without diabetes, patients with diabetes (n = 3,440, 36.5%) had higher cumulative rates of 1-year all-cause death (9.4% vs. 7.2%; adjusted hazard ratio [HR] 1.28; 95% CI 1.07–1.54), CVD death (4.8% vs. 3.8%; adjusted HR 1.28; 95% CI 0.99–1.66), and HF hospitalization (13.8% vs. 9.3%; adjusted HR 1.37; 95% CI 1.17–1.60), all independent of age, sex, BMI, smoking, systolic blood pressure, estimated glomerular filtration rate, hemoglobin, HF etiology, left ventricular ejection fraction, hypertension, statin use, and prior stroke or chronic obstructive pulmonary disease. Among CHF patients with HbA1c measurements available at baseline (n = 2,567), there was a significant and independent association between increasing HbA1c levels and the risk of 1-year survival outcomes. CONCLUSIONS: The presence of diabetes markedly increases the risk of 1-year adverse clinical outcomes in outpatients with CHF independent of multiple common risk factors. More effective and personalized treatment for diabetes should be considered in this particularly high-risk patient population.
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Available observational data demonstrate that diabetes prevalence in patients with heart failure is similar irrespective of left ventricular ejection fraction category.
“In addition, available data from observational studies demonstrate that diabetes prevalence in patients with HF is similar, irrespective of LVEF category.469,470”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [469]
T2DM is often unrecognized in HF patients, and vice versa.
“T2DM is often unrecognized in HF patients, and vice versa, which emphasizes the importance of an active search for both”
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 [73]
In the ESC HF Long-Term Registry, the presence of T2DM was independently associated with increased 1-year all-cause mortality.
“Likewise, in the ESC HF Long-Term Registry, the presence of T2DM was independently associated with increased 1-year all-cause mortality.51,73”
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 [73]
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 [73]
In the recent ESC HF Long-Term Registry and in the CHARM trial, T2DM was a risk factor for mortality in both men and women.
“Likewise, in the recent ESC HF Long-Term Registry and in the CHARM trial, T2DM was a risk factor for mortality in both men and women.1,73”
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 [73]
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- Authors
- Dauriz, M., Targher, G., Laroche, C., Temporelli, P. L., Ferrari, R., Anker, S., Coats, A., Filippatos, G., Crespo-Leiro, M., Mebazaa, A., Piepoli, M. F., Maggioni, A. P., Tavazzi, L., & for the ESC-HFA Heart Failure Long-Term Registry
- Affiliations
- University of Verona (IT)
- European Society of Cardiology (FR)
- Fondazione Salvatore Maugeri (IT)
- University of Ferrara (IT)
- Universitätsmedizin Göttingen (DE)
- University of Warwick (GB)
- Hospital Universitario 12 De Octubre (ES)
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruña, La Coruña, Spain
- Inserm (FR)
- Guglielmo da Saliceto Hospital (IT)
- Corresponding author
- Maggioni, Aldo P.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2017-03-02
- Volume
- 40
- Issue
- 5
- Pages
- 671-678
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2593947461
- Cited by
- 139
- References
- 27
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 16 · 2023: 20 · 2022: 17 · 2021: 18 · 2020: 12 · 2019: 20 · 2018: 11 · 2017: 5
- FWCI
- 10.14
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- GRO (submittedVersion)
- RUC (Universidade Da Coruña) (submittedVersion, other-oa)
- Funders
- Abbott Vascular Int.
- Amgen Cardiovascular
- AstraZeneca Australia
- Bayer
- Boehringer Ingelheim
- Boston Scientific
- The Bristol Myers Squibb and Pfizer Alliance
- The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company
- Gedeon Richter Plc
- Menarini Int. Op.
- MSD-Merck & Co.
- Novartis Pharma AG
- ResMed Foundation
- Sanofi
- SERVIER
- Edwards Lifesciences
- 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, chronic heart failure, all-cause mortality, cardiovascular mortality, heart failure hospitalization, HbA1c, glycemic control, outpatients, adverse clinical outcomes
- MeSH terms
- Aged, Cardiovascular Diseases, Cause of Death, Chronic Disease, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Registries, Risk Factors, Time Factors, Proportional Hazards Models, Diabetes Complications
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