Mortality risk factors in patients with advanced heart failure and diabetes mellitus

Abstract

BACKGROUND: An accurate assessment of prognosis is an important element of the management of patients with advanced heart failure (HF) and diabetes mellitus, because the cooccurrence of these 2 diseases has a particularly unfavorable effect on their course and treatment efficacy. AIMS: The aim of the study was to determine the prognostic factors affecting survival in patients with HF and diabetes. METHODS: This was a retrospective analysis of clinical and laboratory data of 367 consecutive patients with advanced HF (New York Heart Association classes III-IV) and diabetes, hospitalized in a tertiary referral center for interventional cardiology between 2009 and 2013. Patients with hematologic disorders, those treated with steroids, and those with incomplete clinical data were excluded. The endpoint of the study was all-cause death. RESULTS: The mean (SD) age of patients was 63.3 (10.8) years; men constituted 75.7% of the study group. During a mean (SD) follow-up of 4.4 (1.3) years, the overall mortality rate was 53.7%. In a multivariate analysis, independent risk factors of death included atrial fibrillation (AF) (hazard ratio [HR], 1.57; 95% CI, 1.14-2.17; P <0.01), red blood cell distribution width (RDW) (HR, 1.05; 95% CI, 1.02-1.07; P <0.0001), and platelet-to-lymphocyte ratio (PLR) (HR, 1.01; 95% CI, 1.01-1.01; P <0.0001). CONCLUSIONS: Our study showed that permanent AF and 2 hematologic parameters, RDW and PLR, are associated with an increased risk of death in a long-term follow-up in patients with advanced HF and concomitant diabetes.