Objective

Evidence suggests diabetes mellitus is an independent risk factor for adverse cardiovascular events in patients with heart failure. As a result, we sought to compare mortality in patients with heart failure with reduced ejection fraction (HFrEF) with and without diabetes.

Research design and methods

The Veteran Affairs Hospitals' databases were queried to identify all veterans diagnosed with HFrEF from 2007 to 2015. From the overall sample of 165,159 veterans, 41,120 patients with diabetes were matched by their propensity scores (without replacement) 1:1 to non-diabetic patients. To estimate the association between diabetes (Type 1 and 2) and overall mortality of HFrEF patients, a Cox proportional hazard model was used on the matched sample and controlled for patient characteristics for a mean follow up of 3.6 years (standard deviation ±2.3).

Results

In a matched sample of 41,120 veterans with HFrEF with and without diabetes, those with diabetes and HFrEF were more often on guideline-directed medical therapy than those without diabetes. In the matched cohort, the mortality risk for patients with concurrent HFrEF and diabetes was 17.7% at 1 year and 74.3% at 5 years, whereas the mortality risk for those without diabetes was 15.3% at 1 year and 69.2% at 5 years. After controlling for patient characteristics such as age, sex, body mass index, heart rate, medical therapies, comorbidities, medications, low-density lipoproteins, high-density lipoproteins, we found that patients with diabetes compared to those without had a significantly increased risk of mortality (HR: 1.85, 95% CI: 1.77–1.92, p < 0.001).

Conclusions

Diabetic HFrEF patients have a higher risk of mortality than non-diabetic HFrEF patients despite controlling for medical therapies and comorbidities.

中文翻译：

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伴有和不伴有糖尿病的心力衰竭和射血分数降低患者的预后：一项为期 7 年的全国退伍军人管理分析

客观的

有证据表明，糖尿病是心力衰竭患者心血管不良事件的独立危险因素。因此，我们试图比较伴有和不伴有糖尿病的射血分数降低（HFrEF）心力衰竭患者的死亡率。

研究设计与方法

对退伍军人事务医院的数据库进行了查询，以确定从 2007 年到 2015 年被诊断出患有 HFrEF 的所有退伍军人。在 165,159 名退伍军人的总体样本中，41,120 名糖尿病患者的倾向评分（无需替换）与非糖尿病患者 1:1 匹配. 为了估计糖尿病（1 型和 2 型）与 HFrEF 患者总体死亡率之间的关联，对匹配样本使用 Cox 比例风险模型，并控制患者特征，平均随访 3.6 年（标准差 ±2.3）。

结果

在 41,120 名 HFrEF 合并和不合并糖尿病的退伍军人的匹配样本中，患有糖尿病和 HFrEF 的人比没有糖尿病的人更经常接受指南指导的药物治疗。在匹配队列中，合并 HFrEF 和糖尿病的患者 1 年死亡风险为 17.7%，5 年死亡风险为 74.3%，而非糖尿病患者的死亡风险为 15.3% 和 5 年 69.2%。在控制了年龄、性别、体重指数、心率、药物治疗、合并症、药物、低密度脂蛋白、高密度脂蛋白等患者特征后，我们发现糖尿病患者与非糖尿病患者相比风险显着增加死亡率（HR：1.85，95% CI：1.77–1.92，p < 0.001）。

结论

尽管控制了药物治疗和合并症，但糖尿病 HFrEF 患者的死亡风险高于非糖尿病 HFrEF 患者。