Cause-specific outcomes in adults with diabetes and heart failure

  • Lawson CA & al.
  • JAMA Netw Open
  • 2 Dec 2019

  • curated by Dawn O'Shea
  • UK Medical News
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Emerging trends in non-cardiovascular disease (CVD) outcomes in patients with type 2 diabetes (T2D) and heart failure (HF) suggest earlier management of co-morbidities is “urgently needed.”

The cohort study used UK primary care data linked to hospital admissions and mortality for 87,709 patients with incident HF between 1998 and 2017. Of the cohort, 23.8 per cent had T2D.

In patients with HF, T2D was associated with an increased risk of unplanned hospital admission (adjusted incidence rate ratio for CVD hospitalisations: 1.24; 95% CI, 1.19-1.30; for non-CVD hospitalisations: 1.26; 95% CI, 1.22-1.30) and an increase in mortality risk (adjusted HR for CVD mortality: 1.06; 95% CI, 1.02-1.10; for non-CVD mortality: 1.24; 95% CI, 1.19-1.29).

Age-standardised one-year mortality risk was 35.6 per cent (95% CI, 35.1-36.1%) in the diabetes group vs 29.2 per cent (95% CI, 29.0-29.5%) in those without diabetes.

During the study period, associations of diabetes with hospitalisation and mortality rates decreased for CVD outcomes but not for non-CVD outcomes.

Age-adjusted one-year hospitalisation rates following HF diagnosis increased similarly for both groups over time (HF with T2D, 1998-2001: 133.3 [95% CI, 102.2-105.4] per 100 person-years; HF with diabetes, 2012-2015: 152.5 [95% CI, 145.5-159.5] per 100 person-years; P for difference in trend=.06). Trends diverged according to cause.

After 2004, a trend emerged showing a greater increase in non-CVD admissions among patients with HF and diabetes than among patients with no diabetes (2.3%; 95% CI, 0.9-3.6% vs 1.1%; 95% CI, 0.8-1.4%).

Presenting the findings in JAMA Network Open, the authors say the higher risk for all cause-specific outcomes and emerging non-CVD trends associated in patients with diabetes and HF indicated an urgent need for earlier co-morbidity management and multimorbidity care.