Impact of new-onset diabetes mellitus and glycemic control on the prognosis of heart failure patients: A propensity-matched study in the community

ObjectivesTo assess the incidence of type 2 diabetes mellitus (DM) in patients with heart failure (HF), and to evaluate the effect of new-onset DM and glycemic control on the prognosis of HF patients treated with a contemporary medical regimen.MethodsProspective study of 5314 HF patients and previously unknown DM during 9 years. Their mean age was 71.8 ± 7.9 years, 53.0% were women, and 50.2% had non-systolic HF. During a median follow-up of 56.9 ± 18.2 months, 68.9% of the patients died, 88.6% were hospitalized for HF, and 1519 (27.3%) developed new-onset DM. We propensity-matched those 1519 HF patients with DM, with 1519 HF patients non-diagnosed with DM.ResultsThe age- and sex-adjusted incidence (per 100 HF patients/years) of DM in HF patients was 3.20, higher in women and in patients with non-systolic HF (p < 0.01). Patients with HF and DM and those with a mean HbA1c > 7.0% presented an increased mortality (HR of death [CI 95%]: 2.44 [1.68-3.19] and, HR: 2.56 [1.77-3.35], respectively), mainly due to an increased cardiovascular mortality (HR ≥ 2.40 [1.46-3.34]) (P < 0.001). The rate of hospitalization, of 30-day readmissions, and the number of visits were higher among HF patients with DM or with HbA1c > 7.0% (p < 0.001). These relationships of DM and its poor metabolic control with prognosis were maintained, independently of the gender, the type of HF (systolic or, non-systolic), the comorbidities, and the medication used (P < 0.01).ConclusionNew-onset diabetes mellitus and its poor metabolic control (HbA1c > 7.0%) are associated with a increased mortality and morbidity of patients with heart failure.