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Type 2 diabetes increases the long-term risk of heart failure and mortality in patients with atrial fibrillation.

Authors :
Polovina M
Lund LH
Đikić D
Petrović-Đorđević I
Krljanac G
Milinković I
Veljić I
Piepoli MF
Rosano GMC
Ristić AD
Ašanin M
Seferović PM
Source :
European journal of heart failure [Eur J Heart Fail] 2020 Jan; Vol. 22 (1), pp. 113-125. Date of Electronic Publication: 2019 Dec 10.
Publication Year :
2020

Abstract

Aims: Impact of type 2 diabetes mellitus (T2DM) on non-thromboembolic outcomes in atrial fibrillation (AF) is insufficiently explored. This prospective cohort study of AF patients aimed (i) to analyse the association between T2DM and heart failure (HF) events (including new-onset HF), and all-cause and cardiovascular mortality, (ii) to assess the impact of baseline T2DM treatment on outcomes, and (iii) to explore characteristics of new-onset HF phenotypes in relation to T2DM status.<br />Methods and Results: Of 1803 AF patients (515/1288, with/without prior HF), 389 (22%) had T2DM at baseline. After 5 years of median follow-up, T2DM patients had an 85% greater risk of HF events [adjusted hazard ratio (aHR) 1.85; 95% confidence interval (CI) 1.51-2.28; P < 0.001], including a 45% increased risk for new-onset HF (1.45; 1.17-2.28; P = 0.015). T2DM conferred a 56% higher all-cause (1.56, 1.22-2.01; P = 0.003) and a 48% higher cardiovascular mortality (1.48; 1.34-1.93; P = 0.007). Fine-Gray analysis, with mortality as a competing risk, confirmed greater HF risk among T2DM patients. All risks were highest among insulin-treated patients. The prevalence of new-onset HF phenotypes was as follows: 67% preserved ejection fraction (HFpEF), 20% mid-range ejection fraction (HFmrEF) and 13% reduced ejection fraction (HFrEF). On time-dependent Cox regression, adjusted for baseline characteristics and an interim acute coronary event, T2DM increased aHRs for new-onset HFpEF (2.38; 1.30-4.58; P <0.001) and the combined HFmrEF/HFrEF (1.77; 1.11-3.62; P = 0.017).<br />Conclusions: Atrial fibrillation patients with T2DM have independently increased risk of new-onset/recurrent HF events, cardiovascular and all-cause mortality, particularly when insulin-treated. The prevailing phenotype of new-onset HF was HFpEF; T2DM conferred higher risk of both HFpEF and HFmrEF/HFrEF.<br /> (© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)

Details

Language :
English
ISSN :
1879-0844
Volume :
22
Issue :
1
Database :
MEDLINE
Journal :
European journal of heart failure
Publication Type :
Academic Journal
Accession number :
31822042
Full Text :
https://doi.org/10.1002/ejhf.1666