Prognostic impact of diabetes on long-term survival outcomes in patients with heart failure: a meta-analysis
Abstract
OBJECTIVE: Several studies have explored the impact of diabetes on mortality in patients with heart failure (HF). However, the extent to which diabetes may confer risk of mortality and hospitalization in this patient population remains imperfectly known. Here we examine the independent prognostic impact of diabetes on the long-term risk of mortality and hospitalization in patients with HF. RESEARCH DESIGN AND METHODS: ≥1,000) observational registries and randomized controlled trials with a follow-up duration of at least 1 year. Eligible studies were selected according to predefined keywords and clinical outcomes. Data from selected studies were extracted, and meta-analysis was performed using random-effects modeling. RESULTS: A total of 31 registries and 12 clinical trials with 381,725 patients with acute and chronic HF and 102,036 all-cause deaths over a median follow-up of 3 years were included in the final analysis. Diabetes was associated with a higher risk of all-cause death (random-effects hazard ratio [HR] 1.28 [95% CI 1.21, 1.35]), cardiovascular death (1.34 [1.20, 1.49]), hospitalization (1.35 [1.20, 1.50]), and the combined end point of all-cause death or hospitalization (1.41 [1.29, 1.53]). The impact of diabetes on mortality and hospitalization was greater in patients with chronic HF than in those with acute HF. Limitations included high heterogeneity and varying degrees of confounder adjustment across individual studies. CONCLUSIONS: This updated meta-analysis shows that the presence of diabetes per se adversely affects long-term survival and risk of hospitalization in patients with acute and chronic HF.
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The coexistence of T2DM and HF is associated with a higher risk of HF hospitalization.
“The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30-40% of patients) and associated with a higher risk of HF hospitalization, all-cause and cardiovascular (CV) mortality.”
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 [93]
The coexistence of T2DM and HF is associated with a higher risk of all-cause mortality.
“The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30-40% of patients) and associated with a higher risk of HF hospitalization, all-cause and cardiovascular (CV) mortality.”
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 [93]
The coexistence of T2DM and HF is associated with a higher risk of cardiovascular mortality.
“The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30-40% of patients) and associated with a higher risk of HF hospitalization, all-cause and cardiovascular (CV) mortality.”
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 [93]
The observed long-term risk of adverse outcomes in HF patients with T2DM appears greater in patients with chronic than in those with acute HF.
“and the observed long-term risk appears greater in patients with chronic than in those with acute HF. 93”
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 [93]
A recent meta-analysis of 31 registries and 12 clinical trials with 381,725 patients with acute and chronic HF, with a median follow-up of 3 years, confirms that T2DM is independently associated with a higher risk of all-cause death (random-effects HR 1.28), cardiovascular death (HR 1.34), hospitalization (HR 1.35), and the combined endpoint of all-cause death or hospitalization (HR 1.41).
“A recent meta-analysis of 31 registries and 12 clinical trials with 381 725 patients with acute and chronic HF, with a median follow-up of 3 years confirms that T2DM is independently associated with a higher risk of all-cause death (random-effects HR 1.28), CV death (HR 1.34), hospitalization (HR 1.35), and the combined endpoint of all-cause death or hospitalization (HR 1.41)”
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 [93]
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References 82 · Cited by 123
- Authors
- Dauriz, M., Mantovani, A., Bonapace, S., Verlato, G., Zoppini, G., Bonora, E., & Targher, G.
- Affiliations
- University of Verona (IT)
- Division of Cardiology, ‘‘Sacro Cuore’’ Hospital, Negrar, Verona, Italy
- Corresponding author
- Targher, Giovanni
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2017-10-12
- Volume
- 40
- Issue
- 11
- Pages
- 1597-1605
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2766249762
- Cited by
- 123
- References
- 82
- Citations by year
- 2026: 12 · 2025: 9 · 2024: 12 · 2023: 9 · 2022: 20 · 2021: 19 · 2020: 19 · 2019: 15 · 2018: 8
- FWCI
- 1.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (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, Cardiovascular Risks, and Lipoproteins
- Keywords
- diabetes mellitus, heart failure, all-cause mortality, cardiovascular mortality, hospitalization, prognosis, chronic heart failure, acute heart failure, long-term survival
- MeSH terms
- Diabetes Mellitus, Heart Failure, Hospitalization, Humans, Prognosis, Registries, Incidence, Randomized Controlled Trials as Topic, Endpoint Determination, Observational Studies as Topic
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