Afib: type 2 diabetes tied to long term risk for heart failure and mortality

  • Polovina M & al.
  • Eur J Heart Fail
  • 10 Dec 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • In patients with atrial fibrillation (Afib), the presence of type 2 diabetes mellitus (T2DM) was associated with an increased risk for new onset/recurrent heart failure (HF) events, cardiovascular (CV) and all-cause mortality, especially, in those treated with insulin.

Why this matters

  • A rising global burden of Afib and its poor prognosis with either incident or concomitant HF highlights the importance of identifying potentially treatable predisposing conditions such as T2DM.

Study design

  • This prospective cohort study evaluated the association of T2DM with HF events and the phenotype of HF and effect of baseline T2DM treatment on outcomes in 1803 patients with Afib (515 with HF and 1288 without HF, 389 had diabetes at baseline).
  • Funding: None disclosed.

Key results

  • After a median follow-up of 5 years, patients with T2DM were at an increased risk for:
    • HF events (adjusted HR [aHR], 1.85; 95% CI, 1.51-2.28; P<.001 and>
    • all-cause (aHR, 1.56; 95% CI, 1.22-2.01; P=.003) and CV (aHR, 1.48; 95% CI, 1.34-1.93; P=.007) mortality.
  • The risk for new-onset HF was significantly higher in patients without a history of HF (aHR, 1.45; 95% CI, 1.17-2.28; P=.015).
  • Compared with patients with Afib and without T2DM, patients with T2DM who received insulin or combined therapy were at an increased risk for:
    • HF events (aHR, 2.61; 95% CI, 2.31-3.08),
    • new-onset HF (aHR, 1.76; 95% CI, 1.51-2.24) and
    • all-cause mortality (aHR, 1.99; 95% CI, 1.74-2.19).
  • In the Cox regression analysis, T2DM was associated with an increased risk for:
    • new-onset HFpEF (aHR, 2.38; 95% CI, 1.30-4.58; P<.001 and>
    • the combined HFmrEF/HFrEF (aHR, 1.77; 95% CI, 1.11-3.62; P=.017).

Limitations

  • Lack of data on T2DM duration and the presence of microvascular complications.