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Impact of diabetes and on-arrival hyperglycemia on short-term outcomes in acute heart failure patients

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Abstract

The impact of diabetes mellitus (DM) and hyperglycemia on short-term prognosis in patients with acute heart failure (AHF) remains controversial as most data comes from series of hospitalized patients. Our purpose was to analyze outcomes in a nation-wide registry of AHF patients attended in emergency department (ED). ED AHF patients were prospectively enrolled, with the index event and the vulnerable post-discharge phase outcomes recorded. The influence of presenting hyperglycemia (> 180 mg/dL) and DM treatment on prognosis were also investigated. All results were adjusted (a) for baseline characteristics. Of 9192 enrolled AHF patients, 4544 (49,4%) were diabetic, with 24% of diabetics and 25.1% of non-diabetic (p = 0.247) directly discharged from the ED also included. Diabetics had higher rates of comorbidities, but were slightly younger and had lower in-hospital and 30 day all-cause mortality than non-diabetics (a-OR = 0.827, 95% CI = 0.690–0980; and a-HR = 0.850, 95% CI = 0.814–1.071, respectively). Conversely, hyperglycemia on-arrival was associated with increased in-hospital, and 30 day all-cause mortality, in both DM (a-OR = 1.933, 95% CI = 1.378–2.712, and a-HR = 1.590, 95% CI = 1.304–1.938, respectively) and non-DM patients (a-OR = 1.498, 95% CI = 1.175–1.909, and a-HR = 1.719, 95% CI = 1.306–2.264, respectively). However, during the vulnerable phase, diabetics had worse short-term outcomes, with higher rates of ED-revisit and rehospitalization. These worse outcomes seemed to be unrelated to the severity of DM. In patients with AHF attended in ED, diabetes was associated with lower index event case fatality, but higher rates of rehospitalization and re-consultation in the vulnerable post-discharge period. Conversely, hyperglycemia at hospital arrival was strongly associated with early mortality, regardless of diabetes status.

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Acknowledgements

This study was possible in part thanks to financial support from the Instituto de Salud Carlos III with funds from the Ministerio de Sanidad and FEDER (PI18/00393, PI18/00773), La Marató de TV3 (2015/2510) and the Generalitat de Cataluna for consolidated research groups (GRC 2009/1385, 2014/0313, 2017/1424). The EAHFE Research group have previously received unconditioned funding from Novartis, Otsuka and Orion Pharma. We thank Alícia Díaz for her professionalism in data management. Investigators of the ICA-SEMES/EAHFE Registry group (full list): Marta Fuentes, Cristina Gil: Hospital Universitario de Salamanca, Héctor Alonso, Enrique Pérez-Llantada: Hospital Marqués de Valdecilla de Santander, Francisco Javier Martín-Sánchez, Guillermo Llopis García, Mar Suárez Cadenas: Hospital Clínico San Carlos de Madrid, Òscar Miró, Víctor Gil, Rosa Escoda, Sira Aguiló, Carolina Sánchez: Hospital Clínic de Barcelona, Javier Millán: Hospital Politénic La Fe de Valencia, José Pavón: Hospital Dr. Negrín de Las Palmas de Gran Canaria, Antonio Noval: Hospital Insular de Las Palmas de Gran Canaria, María Luisa López-Grima, Amparo Valero, María Ángeles Juan: Hospital Dr. Peset de Valencia, Alfons Aguirre, Maria Angels Pedragosa, Silvia Mínguez Masó: Hospital del Mar de Barcelona, María Isabel Alonso, Francisco Ruiz: Hospital de Valme de Sevilla, José Miguel Franco: Hospital Miguel Servet de Zaragoza, Ana Belén Mecina: Hospital de Alcorcón de Madrid, Josep Tost, Marta Berenguer, Ruxandra Donea: Consorci Sanitari de Terrassa, Susana Sánchez Ramón, Virginia Carbajosa Rodríguez: Hospital Universitario Rio Hortega de Valladolid, Pascual Piñera, José Andrés Sánchez Nicolás: Hospital Reina Sofía de Murcia, Raquel Torres Garate: Hospital Severo Ochoa de Madrid, Aitor Alquézar-Arbé, Miguel Alberto Rizzi, Sergio Herrera: Hospital de la Santa Creu y Sant Pau de Barcelona, Javier Jacob, Alex Roset, Irene Cabello, Antonio Haro: Hospital Universitari de Bellvitge de Barcelona, Fernando Richard, José María Álvarez Pérez, María Pilar López Diez: Hospital Universitario de Burgos, Pablo Herrero Puente, Joaquín Vázquez Álvarez, Belén Prieto García, María García Díez, Marta Sánchez González: Hospital Universitario Central de Asturias de Oviedo, Pere Llorens, Patricia Javaloyes, Inmaculada Jiménez, Néstor Hernández, Begoña Espinosa, Adriana Gil, Francisca Molina, Tamara García: Hospital General de Alicante, Juan Antonio Andueza: Hospital General Universitario Gregorio Marañón de Madrid, Rodolfo Romero: Hospital Universitario de Getafe de Madrid, Martín Ruíz, Roberto Calvache: Hospital de Henares de Madrid, María Teresa Lorca Serralta, Luis Ernesto Calderón Jave: Hospital del Tajo de Madrid, Beatriz Amores Arriaga, Beatriz Sierra Bergua: Hospital Clínico Lozano Blesa de Zaragoza, Enrique Martín Mojarro, Brigitte Silvana Alarcón Jiménez: Hospital Sant Pau i Santa Tecla de Tarragona, Lisette Travería Bécquer, Guillermo Burillo: Hospital Universitario de Canarias de Tenerife, Lluís Llauger García, Gerard Corominas LaSalle: Hospital Universitari de Vic de Barcelona, Carmen Agüera Urbano, Ana Belén García Soto, Elisa Delgado Padial: Hospital Costa del Sol de Marbella de Málaga, Ester Soy Ferrer, María Adroher Múñoz: Hospital Josep Trueta de Girona. José Manuel Garrido: Hospital Virgen Macarena de Sevilla, Francisco Javier Lucas-Imbernón: Hospital General Universitario de Albacete, Rut Gaya: Hospital Juan XXIII de Tarragona, Carlos Bibiano, María Mir, Beatriz Rodríguez: Hospital Infanta Leonor de Madrid, José Luis Carballo: Complejo Hospitalario Universitario de Ourense, Esther Rodríguez-Adrada, Belén Rodríguez Miranda, Monika Vicente Martín: Hospital Rey Juan Carlos de Móstoles de Madrid. Pere Coma Casanova, Joan Espinach Alvarós: Hospital San Joan de Deu de Martorell, Barcelona.

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Authors and Affiliations

  1. Research Department, Consorci Sanitari Integral, University of Barcelona, Av. Josep Molins, 29, L’Hospitalet de Llobegat, 08096, Barcelona, Catalonia, Spain

    Josep Masip

  2. Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain

    Marina Povar-Echeverría

  3. Emergency Department, Baylor Medical School, Houston, Texas, USA

    William Frank Peacock

  4. Emergency Department, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat Universitat de Barcelona, Barcelona, Catalonia, Spain

    Javier Jacob

  5. Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Catalonia, Spain

    Víctor Gil, Carolina Sánchez & Òscar Miró

  6. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    Pablo Herrero

  7. Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain

    Pere Llorens

  8. Emergency Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Catalonia, Spain

    Aitor Alquézar-Arbé

  9. Emergency Department, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain

    Francisco Javier Martín-Sánchez

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  1. Josep Masip
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  2. Marina Povar-Echeverría
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  5. Víctor Gil
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  9. Carolina Sánchez
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  10. Francisco Javier Martín-Sánchez
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  11. Òscar Miró
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Consortia

On Behalf of the Researchers of the ICA-SEMES and EAHFE Registry

  • Marta Fuentes
  • , Cristina Gil
  • , Héctor Alonso
  • , Enrique Pérez-Llantada
  • , Francisco Javier Martín-Sánchez
  • , Guillermo Llopis García
  • , Mar Suárez Cadenas
  • , Òscar Miró
  • , Víctor Gil
  • , Rosa Escoda
  • , Sira Aguiló
  • , Carolina Sánchez
  • , Javier Millán
  • , José Pavón
  • , Antonio Noval
  • , María Luisa López-Grima
  • , Amparo Valero
  • , María Ángeles Juan
  • , Alfons Aguirre
  • , Maria Angels Pedragosa
  • , Silvia Mínguez Masó
  • , María Isabel Alonso
  • , Francisco Ruiz
  • , José Miguel Franco
  • , Ana Belén Mecina
  • , Josep Tost
  • , Marta Berenguer
  • , Ruxandra Donea
  • , Susana Sánchez Ramón
  • , Virginia Carbajosa Rodríguez
  • , Pascual Piñera
  • , José Andrés Sánchez Nicolás
  • , Raquel Torres Garate
  • , Aitor Alquézar-Arbé
  • , Miguel Alberto Rizzi
  • , Sergio Herrera
  • , Javier Jacob
  • , Alex Roset
  • , Irene Cabello
  • , Antonio Haro
  • , Fernando Richard
  • , José María Álvarez Pérez
  • , María Pilar López Diez
  • , Pablo Herrero Puente
  • , Joaquín Vázquez Álvarez
  • , Belén Prieto García
  • , María García Díez
  • , Marta Sánchez González
  • , Pere Llorens
  • , Patricia Javaloyes
  • , Inmaculada Jiménez
  • , Néstor Hernández
  • , Begoña Espinosa
  • , Adriana Gil
  • , Francisca Molina
  • , Tamara García
  • , Juan Antonio Andueza
  • , Rodolfo Romero
  • , Martín Ruíz
  • , Roberto Calvache
  • , María Teresa Lorca Serralta
  • , Luis Ernesto Calderón Jave
  • , Beatriz Amores Arriaga
  • , Beatriz Sierra Bergua
  • , Enrique Martín Mojarro
  • , Brigitte Silvana Alarcón Jiménez
  • , Lisette Travería Bécquer
  • , Guillermo Burillo
  • , Lluís Llauger García
  • , Gerard Corominas LaSalle
  • , Carmen Agüera Urbano
  • , Ana Belén García Soto
  • , Elisa Delgado Padial
  • , Ester Soy Ferrer
  • , María Adroher Múñoz
  • , José Manuel Garrido
  • , Francisco Javier Lucas-Imbernón
  • , Rut Gaya
  • , Carlos Bibiano
  • , María Mir
  • , Beatriz Rodríguez
  • , José Luis Carballo
  • , Esther Rodríguez-Adrada
  • , Belén Rodríguez Miranda
  • , Monika Vicente Martín
  • , Pere Coma Casanova
  •  & Joan Espinach Alvarós

Contributions

The study is original and has not been submitted elsewhere. None of the paper’s contents have been previously published. All the authors have participated in the design of the study and have reviewed, approved the content of the article and agreed to be accountable for all aspects of the work. The majority have also contributed introducing patients and/or coordinating their inclusion.

Corresponding author

Correspondence to Josep Masip.

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Conflict of interest

All the authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Ethical approval

The EAHFE Registry protocol was approved by a central Ethics Committee at the Hospital Universitario Central de Asturias (Oviedo, Spain) with the reference numbers for phases 5 and 6 being 160/15 and 205/17. Due to the non-interventional design of the registry, Spanish legislation allows central Ethical Committee approval, accompanied by notification to the local Ethical Committees. All participating patients gave informed consent to be included and to be contacted for follow up. The present study was carried out in strict compliance with the Declaration of Helsinki principles.

Informed consent

All participants gave their informed consent prior the participation. It is specified that this consent was for their inclusion to the study and to be contacted later in the follow-up.

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Masip, J., Povar-Echeverría, M., Peacock, W.F. et al. Impact of diabetes and on-arrival hyperglycemia on short-term outcomes in acute heart failure patients. Intern Emerg Med 17, 1503–1516 (2022). https://doi.org/10.1007/s11739-022-02965-3

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