Use of Guideline-Based Treatment Common in Diabetic Congestive Heart Failure Patients
August 15, 2007
by Josh Murphy
Widespread use of guideline-based medications may contribute to an improved prognosis for patients with diabetes mellitus hospitalized for congestive heart failure (CHF), according to investigators with the OPTIMIZE-HF registry1.
In the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF), investigators enrolled 48,612 diabetic and non-diabetic patients hospitalized for CHF in the United States. The purpose of the program was to provide optimal medical care and education to hospitalized CHF patients.
Among the entire cohort 42% had diabetes, with 40% insulin-treated. Rates of in-hospital mortality were similar between diabetic and non-diabetic patients (3.6 vs 3.9%, P=0.08), while length of hospital stay was slightly longer in patients with diabetes (5.9 vs 5.5 days, P<0.0001).
On discharge, patients with diabetes were slightly less likely to be treated with an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) (Figure 1) but were slightly more likely to be treated with a beta blocker (Figure 1).
In patients with available follow-up data to 90 days post-discharge, diabetic patients with left ventricular systolic dysfunction were significantly more likely to be on an ACE inhibitor, ARB, or beta blocker compared to non-diabetic patients (Figure 2).
In patients without left ventricular systolic dysfunction, all-cause mortality was significantly lower in diabetic compared to non-diabetic patients (6.2 vs 9.2%, P=0.008).
Although diabetic patients were more likely to be rehospitalized for CHF (Figure 3), diabetes was not a significant independent predictor of mortality be it in-hospital (OR 1.00, 95% CI 0.88-1.14), post-discharge (OR 1.08, 95% CI 0.87-1.35), or during days 60-90 after discharge (OR 1.06, 95% CI 0.92-1.22).
The high rate of beta blocker usage in diabetic patients is significant since it has been demonstrated to be associated with unfavorable glycemic and metabolic effects, investigators note.
"These results provide additional support for the use of aggressive evidence-based therapies in HF patients with DM, and they challenge traditional lines of thought on the difficulties in treating this at-risk patient population."
