Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database.

Raw data of the paper: Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database. <strong>Background. </strong>The prognostic role of diabetes mellitus (DM) in heart failure (HF) patients is undefined, since DM is outweighed by several DM-related variables when confounders are considered. We determined the prognostic role of DM, treatment and glycemic control, in a real-life HF population. <strong>Methods. </strong>3927 HF patients included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score database were evaluated with median follow-up of 3.66 years (IQR 1.70-6.67). Data analysis considered survival between DM (n=897) vs. non-DM (n=3030) patients, and, in diabetics, between insulin (n=304), oral antidiabetics (n=479), and dietary only (n=88) treatments. The role of glycemic control was evaluated grouping DM patients according to glycated hemoglobin (HbA1c): &lt;7% (n=266), 7.1-8% (n=133), &gt;8% (n=149). All analyses were performed also adjusting for ejection fraction, renal function, hemoglobin, sodium, exercise peak oxygen uptake, and ventilation/carbon dioxide relationship slope. Study primary endpoint was the composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Secondary endpoints were cardiovascular and all causes death. <strong>Results. </strong>For all endpoints, upon adjustment for confounders, DM status and insulin treatment or dietary regimen were not significantly associated with adverse long-term prognosis compared to non-DM and oral antidiabetic treated patients, respectively. A worse prognosis was observed in HbA1c &gt;8% patients (Log-Rank p&lt;0.001), even after correction for confounding factors. All results were replicated by hazard ratio analysis. <strong>Conclusion. </strong>In HF patients, DM, insulin treatment and dietary regimen are not adverse outcome predictors. The only condition related to long-term prognosis considering potential confounders is poor glycemic control.