Long-term Survival And Factors Associated With Chronic Kidney Disease Requiring Dialysis Post Orthotopic Heart Transplantation.
HFSA ePoster Library. Okwuosa I. 09/10/21; 343506; 27
Ike Okwuosa
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Abstract
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Background: Diabetes is associated with increased mortality in patients with stage C heart failure (HF), but the prevalence of diabetes and its complications, and their association with mortality in advanced (stage D) HF is unclear.
Methods: We conducted a population-based cohort study of all adult residents of Olmsted County, Minnesota with advanced HF from 2007-2017. Patients with diabetes were identified using validated HEDIS criteria. Diabetes complications were assessed using the Diabetes Complications Severity Index (DCSI), with 1 point each for retinopathy, nephropathy, neuropathy, cerebrovascular disease, cardiovascular disease, peripheral vascular disease, and acute metabolic events. Associations between diabetes and all-cause mortality; and hemoglobin A1c (HbA1c) and DCSI in patients with diabetes and all-cause mortality, were assessed using multivariable Cox proportional hazard regression models.
Results: Of 936 patients with advanced HF, 338 (36.1%) had diabetes. Compared with patients without diabetes, those with diabetes were younger (mean age 75.0 versus 77.9 years, p=0.003) with higher body mass index (mean 34.9 versus 28.1 kg/m2, p<0.001), worse renal function (mean creatinine 1.7 versus 1.5 mg/dL, p=0.005), and a higher prevalence of several comorbidities. Mean ejection fraction was slightly higher (45.1% vs. 42.6%, p=0.039), and moderate or greater right ventricular dysfunction was less common (25.7% versus 35.1%, p=0.003) in patients with diabetes compared to those without. Among patients with diabetes, the most common non-cardiovascular diabetes complications were nephropathy (72.8%) and neuropathy (53.8%). Overall, median (IQR) survival after development of advanced HF was 13.1 (3.9-33.1) months; mortality did not vary by diabetes status (adjusted HR 1.03, 95% CI 0.88-1.19, p=0.73) or by HbA1c in those with diabetes (adjusted HR 1.01 per 1% increase, 95% CI 0.93-1.10, p=0.82). However, a stepwise increase in mortality risk was observed with increasing DCSI count (p=0.035). Patients with diabetes and 4 (adjusted HR 1.24, 95% CI 0.92-1.67) or 5-7 (adjusted HR 1.49, 95% CI 1.09-2.03) diabetes complications were at increased mortality risk compared to those with ≤3 complications.
Conclusions: More than one-third of patients with advanced HF have diabetes. While the stage D HF/ diabetes phenogroup has unique clinical characteristics, the lack of association of diabetes with mortality risk suggests that the high mortality in advanced HF is driven by the advanced HF state.
Methods: We conducted a population-based cohort study of all adult residents of Olmsted County, Minnesota with advanced HF from 2007-2017. Patients with diabetes were identified using validated HEDIS criteria. Diabetes complications were assessed using the Diabetes Complications Severity Index (DCSI), with 1 point each for retinopathy, nephropathy, neuropathy, cerebrovascular disease, cardiovascular disease, peripheral vascular disease, and acute metabolic events. Associations between diabetes and all-cause mortality; and hemoglobin A1c (HbA1c) and DCSI in patients with diabetes and all-cause mortality, were assessed using multivariable Cox proportional hazard regression models.
Results: Of 936 patients with advanced HF, 338 (36.1%) had diabetes. Compared with patients without diabetes, those with diabetes were younger (mean age 75.0 versus 77.9 years, p=0.003) with higher body mass index (mean 34.9 versus 28.1 kg/m2, p<0.001), worse renal function (mean creatinine 1.7 versus 1.5 mg/dL, p=0.005), and a higher prevalence of several comorbidities. Mean ejection fraction was slightly higher (45.1% vs. 42.6%, p=0.039), and moderate or greater right ventricular dysfunction was less common (25.7% versus 35.1%, p=0.003) in patients with diabetes compared to those without. Among patients with diabetes, the most common non-cardiovascular diabetes complications were nephropathy (72.8%) and neuropathy (53.8%). Overall, median (IQR) survival after development of advanced HF was 13.1 (3.9-33.1) months; mortality did not vary by diabetes status (adjusted HR 1.03, 95% CI 0.88-1.19, p=0.73) or by HbA1c in those with diabetes (adjusted HR 1.01 per 1% increase, 95% CI 0.93-1.10, p=0.82). However, a stepwise increase in mortality risk was observed with increasing DCSI count (p=0.035). Patients with diabetes and 4 (adjusted HR 1.24, 95% CI 0.92-1.67) or 5-7 (adjusted HR 1.49, 95% CI 1.09-2.03) diabetes complications were at increased mortality risk compared to those with ≤3 complications.
Conclusions: More than one-third of patients with advanced HF have diabetes. While the stage D HF/ diabetes phenogroup has unique clinical characteristics, the lack of association of diabetes with mortality risk suggests that the high mortality in advanced HF is driven by the advanced HF state.
Background: Diabetes is associated with increased mortality in patients with stage C heart failure (HF), but the prevalence of diabetes and its complications, and their association with mortality in advanced (stage D) HF is unclear.
Methods: We conducted a population-based cohort study of all adult residents of Olmsted County, Minnesota with advanced HF from 2007-2017. Patients with diabetes were identified using validated HEDIS criteria. Diabetes complications were assessed using the Diabetes Complications Severity Index (DCSI), with 1 point each for retinopathy, nephropathy, neuropathy, cerebrovascular disease, cardiovascular disease, peripheral vascular disease, and acute metabolic events. Associations between diabetes and all-cause mortality; and hemoglobin A1c (HbA1c) and DCSI in patients with diabetes and all-cause mortality, were assessed using multivariable Cox proportional hazard regression models.
Results: Of 936 patients with advanced HF, 338 (36.1%) had diabetes. Compared with patients without diabetes, those with diabetes were younger (mean age 75.0 versus 77.9 years, p=0.003) with higher body mass index (mean 34.9 versus 28.1 kg/m2, p<0.001), worse renal function (mean creatinine 1.7 versus 1.5 mg/dL, p=0.005), and a higher prevalence of several comorbidities. Mean ejection fraction was slightly higher (45.1% vs. 42.6%, p=0.039), and moderate or greater right ventricular dysfunction was less common (25.7% versus 35.1%, p=0.003) in patients with diabetes compared to those without. Among patients with diabetes, the most common non-cardiovascular diabetes complications were nephropathy (72.8%) and neuropathy (53.8%). Overall, median (IQR) survival after development of advanced HF was 13.1 (3.9-33.1) months; mortality did not vary by diabetes status (adjusted HR 1.03, 95% CI 0.88-1.19, p=0.73) or by HbA1c in those with diabetes (adjusted HR 1.01 per 1% increase, 95% CI 0.93-1.10, p=0.82). However, a stepwise increase in mortality risk was observed with increasing DCSI count (p=0.035). Patients with diabetes and 4 (adjusted HR 1.24, 95% CI 0.92-1.67) or 5-7 (adjusted HR 1.49, 95% CI 1.09-2.03) diabetes complications were at increased mortality risk compared to those with ≤3 complications.
Conclusions: More than one-third of patients with advanced HF have diabetes. While the stage D HF/ diabetes phenogroup has unique clinical characteristics, the lack of association of diabetes with mortality risk suggests that the high mortality in advanced HF is driven by the advanced HF state.
Methods: We conducted a population-based cohort study of all adult residents of Olmsted County, Minnesota with advanced HF from 2007-2017. Patients with diabetes were identified using validated HEDIS criteria. Diabetes complications were assessed using the Diabetes Complications Severity Index (DCSI), with 1 point each for retinopathy, nephropathy, neuropathy, cerebrovascular disease, cardiovascular disease, peripheral vascular disease, and acute metabolic events. Associations between diabetes and all-cause mortality; and hemoglobin A1c (HbA1c) and DCSI in patients with diabetes and all-cause mortality, were assessed using multivariable Cox proportional hazard regression models.
Results: Of 936 patients with advanced HF, 338 (36.1%) had diabetes. Compared with patients without diabetes, those with diabetes were younger (mean age 75.0 versus 77.9 years, p=0.003) with higher body mass index (mean 34.9 versus 28.1 kg/m2, p<0.001), worse renal function (mean creatinine 1.7 versus 1.5 mg/dL, p=0.005), and a higher prevalence of several comorbidities. Mean ejection fraction was slightly higher (45.1% vs. 42.6%, p=0.039), and moderate or greater right ventricular dysfunction was less common (25.7% versus 35.1%, p=0.003) in patients with diabetes compared to those without. Among patients with diabetes, the most common non-cardiovascular diabetes complications were nephropathy (72.8%) and neuropathy (53.8%). Overall, median (IQR) survival after development of advanced HF was 13.1 (3.9-33.1) months; mortality did not vary by diabetes status (adjusted HR 1.03, 95% CI 0.88-1.19, p=0.73) or by HbA1c in those with diabetes (adjusted HR 1.01 per 1% increase, 95% CI 0.93-1.10, p=0.82). However, a stepwise increase in mortality risk was observed with increasing DCSI count (p=0.035). Patients with diabetes and 4 (adjusted HR 1.24, 95% CI 0.92-1.67) or 5-7 (adjusted HR 1.49, 95% CI 1.09-2.03) diabetes complications were at increased mortality risk compared to those with ≤3 complications.
Conclusions: More than one-third of patients with advanced HF have diabetes. While the stage D HF/ diabetes phenogroup has unique clinical characteristics, the lack of association of diabetes with mortality risk suggests that the high mortality in advanced HF is driven by the advanced HF state.
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