Skip to main content
SpringerLink
Log in

Impact of diabetes mellitus on quality of life in patients with congestive heart failure

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Objectives

Congestive heart failure (CHF) and diabetes mellitus (DM) are increasing in prevalence. There are conflicting data regarding the crosstalk of DM and CHF with respect to the prognostic impact for the patients. Health-related quality of life (Hr-QoL) has been reported to be useful for risk stratification. The purpose of this study was to investigate the impact of DM on Hr-QoL in a CHF population.

Methods

325 consecutive patients with CHF were retrospectively analyzed (age 49 ± 12 years, 74.2% male, 18% had diabetes). After a median follow-up time of 7.4 years, we compared Hr-QoL of patients with and without DM. Hr-QoL was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Kaplan–Meier curves were used to compare survival.

Results

The presence of DM reduced Hr-QoL in patients with CHF, indicated by a higher overall MLHFQ score (43.5 vs. 21, P = 0.013). Kaplan–Meier survival curves showed a significant survival difference (P = 0.024). Survival rates of both groups differed significantly after 3 (P = 0.031), 5 (P = 0.006), and 10 years (P = 0.047) favoring the group without DM.

Conclusions

In patients with CHF, the coexistence of DM is associated with a reduced Hr-QoL and a particularly poor long-term survival. Our results indicate that CHF patients with DM are at increased risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fang, J., Mensah, G. A., Croft, J. B., & Keenan, N. L. (2008). Heart failure-related hospitalization in the U.S., 1979 to 2004. Journal of the American College of Cardiology, 52(6), 428–434.

    Article  PubMed  Google Scholar 

  2. WRITING GROUP MEMBERS, Lloyd-Jones, D., Adams, R. J., Brown, T. M., Carnethon, M., Dai, S., De Simone, G., Ferguson, T. B., Ford, E., Furie, K., Gillespie, C., Go, A., Greenlund, K., Haase, N., Hailpern, S., Ho, P. M., Howard, V., Kissela, B., Kittner, S., Lackland, D., Lisabeth, L., Marelli, A., McDermott, M. M., Meigs, J., Mozaffarian, D., Mussolino, M., Nichol, G., Roger, V. L., Rosamond, W., Sacco, R., Sorlie, P., Stafford, R., Thom, T., Wasserthiel-Smoller, S., Wong, N. D., Wylie-Rosett, J., Committee, on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive Summary: Heart Disease and Stroke Statistics–2010 Update: A Report From the American Heart Association. Circulation, 121(7), 948–954.

  3. Jessup, M., Abraham, W. T., Casey, D. E., Feldman, A. M., Francis, G. S., Ganiats, T. G., Konstam, M. A., Mancini, D. M., Rahko, P. S., Silver, M. A., Stevenson, L. W., & Yancy, C. W. (2009). 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation. Circulation, 119(14), 1977–2016.

  4. Krumholz, H. M., Peterson, E. D., Ayanian, J. Z., Chin, M. H., DeBusk, R. F., Goldman, L., et al. (2005). Report of the national heart, lung, and blood institute working group on outcomes research in cardiovascular disease. Circulation, 111(23), 3158–3166.

    Article  PubMed  Google Scholar 

  5. Mommersteeg, P. M. C., Denollet, J., Spertus, J. A., & Pedersen, S. S. (2009). Health status as a risk factor in cardiovascular disease: A systematic review of current evidence. American Heart Journal, 157(2), 208–218.

    Article  PubMed  Google Scholar 

  6. Bekelman, D. B., Havranek, E. P., Becker, D. M., Kutner, J. S., Peterson, P. N., Wittstein, I. S., et al. (2007). Symptoms, depression, and quality of life in patients with heart failure. Journal of Cardiac Failure, 13(8), 643–648.

    Article  PubMed  Google Scholar 

  7. Rector, T. S., Anand, I. S., & Cohn, J. N. (2006). Relationships between clinical assessments and patients’ perceptions of the effects of heart failure on their quality of life. Journal of Cardiac Failure, 12(2), 87–92.

    Article  PubMed  Google Scholar 

  8. Hallas, C. N., Wray, J., Andreou, P., & Banner, N. R. (2011). Depression and perceptions about heart failure predict quality of life in patients with advanced heart failure. Heart & Lung: The Journal of Acute and Critical Care, 40(2), 111–121.

    Article  Google Scholar 

  9. Evangelista, L. S., Moser, D. K., Westlake, C., Hamilton, M. A., Fonarow, G. C., & Dracup, K. (2006). Impact of obesity on quality of life and depression in patients with heart failure. European Journal of Heart Failure, 8(7), 750–755.

    Article  PubMed  Google Scholar 

  10. Kato, N., Kinugawa, K., Seki, S., Shiga, T., Hatano, M., Yao, A., et al. (2011). Quality of life as an independent predictor for cardiac events and death in patients with heart failure. Circulation Journal, 75(7), 1661–1669.

    Article  PubMed  Google Scholar 

  11. Cohen-Solal, A., Beauvais, F., & Logeart, D. (2008). Heart failure and diabetes mellitus: Epidemiology and management of an alarming association. Journal of Cardiac Failure, 14(7), 615–625.

    Article  PubMed  Google Scholar 

  12. From, A. M., Leibson, C. L., Bursi, F., Redfield, M. M., Weston, S. A., Jacobsen, S. J., et al. (2006). Diabetes in heart failure: Prevalence and impact on outcome in the population. The American Journal of Medicine, 119(7), 591–599.

    Article  PubMed  Google Scholar 

  13. Adams, J. K. F., Fonarow, G. C., Emerman, C. L., LeJemtel, T. H., Costanzo, M. R., Abraham, W. T., et al. (2005). Characteristics and outcomes of patients hospitalized for heart failure in the United States: Rationale, design, and preliminary observations from the first 100, 000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). American Heart Journal, 149(2), 209–216.

    Article  PubMed  Google Scholar 

  14. Kamalesh, M., & Nair, G. (2005). Disproportionate increase in prevalence of diabetes among patients with congestive heart failure due to systolic dysfunction. International Journal of Cardiology, 99(1), 125–127.

    Article  PubMed  Google Scholar 

  15. American Diabetes Association (2006). Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 29(Suppl 1), s43–s48.

    Google Scholar 

  16. Garin, O., Ferrer, M., Pont, À., Rué, M., Kotzeva, A., Wiklund, I., et al. (2009). Disease-specific health-related quality of life questionnaires for heart failure: A systematic review with meta-analyses. Quality of Life Research, 18(1), 71–85.

    Article  PubMed  Google Scholar 

  17. Morgan, K., McGee, H., & Shelley, E. (2007). Quality of life assessment in heart failure interventions: a 10-year (1996–2005) review. European Journal of Cardiovascular Prevention & Rehabilitation, 14(5), 589–607. doi:510.1097/HJR.1090b1013e32828622c32828623.

    Article  Google Scholar 

  18. Bennett, S. J., Oldridge, N. B., Eckert, G. J., Embree, J. L., Browning, S., Hou, N., et al. (2002). Discriminant properties of commonly used quality of life measures in heart failure. Quality of Life Research, 11(4), 349–359.

    Article  Google Scholar 

  19. Reiss, N., Kleikamp, G., Tenderich, G., Tschöpe, D., & Körfer, R. (2008). Diabetes mellitus und Herzinsuffizienz–Inzidenz und chirurgische Therapieoptionen. Herz, 33(3), 206–210.

    Article  PubMed  Google Scholar 

  20. Ruo, B., Rumsfeld, J. S., Hlatky, M. A., Liu, H., Browner, W. S., & Whooley, M. A. (2003). Depressive symptoms and health-related quality of life. JAMA: The Journal of the American Medical Association, 290(2), 215–221.

    Article  Google Scholar 

  21. Alla, F., Briançon, S., Guillemin, F., Juillière, Y., Mertès, P.-M., Villemot, J.-P., et al. (2002). Self-rating of quality of life provides additional prognostic information in heart failure. Insights into the EPICAL study. European Journal of Heart Failure, 4(3), 337–343.

    Article  PubMed  Google Scholar 

  22. Kosiborod, M., Soto, G. E., Jones, P. G., Krumholz, H. M., Weintraub, W. S., Deedwania, P., et al. (2007). Identifying heart failure patients at high risk for near-term cardiovascular events with serial health status assessments. Circulation, 115(15), 1975–1981.

    Article  PubMed  Google Scholar 

  23. Jung, C., Rafnsson, A., Shemyakin, A., Böhm, F., & Pernow, J. (2010). Different subpopulations of endothelial progenitor cells and circulating apoptotic progenitor cells in patients with vascular disease and diabetes. International Journal of Cardiology, 143(3), 368–372.

    Article  PubMed  Google Scholar 

  24. Hoekstra, T., Lesman-Leegte, I., van Veldhuisen, D. J., Sanderman, R., & Jaarsma, T. (2011). Quality of life is impaired similarly in heart failure patients with preserved and reduced ejection fraction. European Journal of Heart Failure, 13(9), 1013–1018.

    Article  PubMed  Google Scholar 

  25. Lewis, E. F., Lamas, G. A., O’Meara, E., Granger, C. B., Dunlap, M. E., McKelvie, R. S., et al. (2007). Characterization of health-related quality of life in heart failure patients with preserved versus low ejection fraction in CHARM. European Journal of Heart Failure, 9(1), 83–91.

    Article  PubMed  Google Scholar 

  26. Tsuchihashi-Makaya, M., Hamaguchi, S., Kinugawa, S., Yokota, T., Goto, D., Yokoshiki, H., et al. (2009). Characteristics and outcomes of hospitalized patients with heart failure and reduced vs preserved ejection fraction. A report from the japanese cardiac registry of heart failure in cardiology (JCARE-CARD). Circulation Journal, 73(10), 1893–1900.

    Article  PubMed  Google Scholar 

  27. Packer, M., Colucci, W. S., Sackner-Bernstein, J. D., Liang, C.-s., Goldscher, D. A., Freeman, I., et al. (1996). Double-blind, placebo-controlled study of the effects of carvedilol in patients with moderate to severe heart failure: The precise trial. Circulation, 94(11), 2793–2799.

    Article  PubMed  CAS  Google Scholar 

  28. Rogers, W., Johnstone, D., Yusuf, S., Weiner, D., Gallagher, P., Bittner, V., et al. (1994). Quality of life among 5,025 patients with left ventricular dysfunction randomized between placebo and enalapril: The studies of left ventricular dysfunction. The SOLVD Investigators. Journal of the American College of Cardiology, 23(2), 393–400.

    Article  PubMed  CAS  Google Scholar 

  29. Mommersteeg, P. M. C., Kupper, N., Schoormans, D., Emons, W., & Pedersen, S. S. (2010). Health-related quality of life is related to cytokine levels at 12 months in patients with chronic heart failure. Brain, Behavior and Immunity, 24(4), 615–622.

    Article  CAS  Google Scholar 

  30. Parissis, J. T., Nikolaou, M., Farmakis, D., Paraskevaidis, I. A., Bistola, V., Venetsanou, K., et al. (2009). Self-assessment of health status is associated with inflammatory activation and predicts long-term outcomes in chronic heart failure. European Journal of Heart Failure, 11(2), 163–169.

    Article  PubMed  Google Scholar 

  31. Farkas, J., Nabb, S., Zaletel-Kragelj, L., Cleland, J. G. F., & Lainscak, M. (2009). Self-rated health and mortality in patients with chronic heart failure. European Journal of Heart Failure, 11(5), 518–524.

    Article  PubMed  Google Scholar 

  32. Subramanian, U., Eckert, G., Yeung, A., & Tierney, W. M. (2007). A single health status question had important prognostic value among outpatients with chronic heart failure. Journal of Clinical Epidemiology, 60(8), 803–811.

    Article  PubMed  Google Scholar 

  33. Heo, S., Moser, D. K., Riegel, B., Hall, L. A., & Christman, N. (2005). Testing the psychometric properties of the Minnesota living with heart failure questionnaire. Nursing Research, 54(4), 265–272.

    Article  PubMed  Google Scholar 

  34. Supino, P. G., Borer, J. S., Franciosa, J. A., Preibisz, J. J., Hochreiter, C., Isom, O. W., et al. (2009). Acceptability and psychometric properties of the Minnesota living with heart failure questionnaire among patients undergoing heart valve surgery: Validation and comparison with SF-36. Journal of Cardiac Failure, 15(3), 267–277.

    Article  PubMed  Google Scholar 

  35. Adams, K. F., Jr, Sueta, C. A., Gheorghiade, M., O’Connor, C. M., Schwartz, T. A., Koch, G. G., et al. (1999). Gender differences in survival in advanced heart failure: Insights from the FIRST study. Circulation, 99(14), 1816–1821.

    Article  PubMed  Google Scholar 

  36. Chin, M. H., & Goldman, L. (1998). Gender differences in 1-year survival and quality of life among patients admitted with congestive heart failure. Medical Care, 36(7), 1033–1046.

    Article  PubMed  CAS  Google Scholar 

  37. Simon, T., Mary-Krause, M., Funck-Brentano, C., & Jaillon, P. (2001). Sex differences in the prognosis of congestive heart failure: Results from the cardiac insufficiency bisoprolol study (CIBIS II). Circulation, 103(3), 375–380.

    Article  PubMed  CAS  Google Scholar 

  38. Varela-Roman, A., Shamagian, L. G., Caballero, E. B., Ramos, P. M., Veloso, P. R., & Gonzalez-Juanatey, J. R. (2005). Influence of diabetes on the survival of patients hospitalized with heart failure: A 12-year study. European Journal of Heart Failure, 7(5), 859–864.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Clinic of Internal Medicine I, Friedrich-Schiller-University, Erlanger Allee 101, 07747, Jena, Germany

    Buntaro Fujita, Alexander Lauten, Bjoern Goebel, Marcus Franz, Michael Fritzenwanger, Markus Ferrari, Hans R. Figulla, Friedhelm Kuethe & Christian Jung

Authors
  1. Buntaro Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander Lauten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bjoern Goebel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcus Franz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Fritzenwanger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Markus Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hans R. Figulla
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Friedhelm Kuethe
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christian Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Jung.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 45 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fujita, B., Lauten, A., Goebel, B. et al. Impact of diabetes mellitus on quality of life in patients with congestive heart failure. Qual Life Res 21, 1171–1176 (2012). https://doi.org/10.1007/s11136-011-0039-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-011-0039-9

Keywords

Search

Navigation