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 PubMed, Scopus, and Web of Science from January 1990 to October 2016 were the data sources used. We included large (n ≥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.

目的几项研究探讨了糖尿病对心力衰竭（HF）患者死亡率的影响。但是，在该患者人群中糖尿病可能给患者带来死亡和住院风险的程度尚不完全清楚。在这里，我们研究了糖尿病对心衰患者长期死亡和住院风险的独立预后影响。

研究设计和方法1990年1月至2016年10月期间的PubMed，Scopus和Web of Science是所使用的数据源。我们包括大（ñ ≥1,000）观测登记和随机对照试验至少1年的随访时间。根据预定义的关键词和临床结果选择符合条件的研究。提取选定研究的数据，并使用随机效应模型进行荟萃分析。

结果最终分析共包括31个登记处和12个临床试验，其中381,725例急慢性HF患者和102,036例全因死亡，平均随访3年。糖尿病与全因死亡的风险更高（随机效应危险比[HR] 1.28 [95％CI 1.21，1.35]），心血管死亡（1.34 [1.20，1.49]），住院（1.35 [1.20，1.50] ]），以及所有原因导致的死亡或住院的综合终点（1.41 [1.29，1.53]）。糖尿病对慢性心力衰竭患者死亡率和住院的影响要大于对急性心力衰竭患者的影响。局限性包括个体研究的高度异质性和不同程度的混杂因素调整。

结论这项最新的荟萃分析表明，糖尿病的存在本身对急性和慢性心力衰竭患者的长期生存和住院风险产生不利影响。