Search

Background: With the advancement in diabetic management throughout the years, this study aimed to compare the effect of diabetes mellitus on mortality in patients with heart failure with reduced ejection fraction (HFrEF). Methods: The VA’s databases were queried to identify all patients diagnosed with HFrEF from 2007 to 2015. A total of 61,400 diabetic patients were matched to as many non-diabetic patients using propensity score matching with replacement. To estimate the impact of diabetic patients on overall mortality of HFrEF patients, the Cox proportional hazard model was used on the matched sample and adjusted for patient characteristics. Results: From the overall sample of 114,010 patients with HFrEF, 61,400 (54%) had diabetes mellitus. On the matched sample, after adjusting for patient characteristics such as age, sex, high beta blocker dose, heart rate quartile, carvedilol, metoprolol, comorbidities, and medications, we found that the diabetic patients were associated with a higher overall mortality compared to non-diabetic patients (HR: 1.50, 95% CI: 1.48-1.53, p Conclusions: Diabetic HFrEF patients have a higher risk of mortality than non-diabetic HFrEF patients despite controlling for beta blocker dose, medications and comorbidities.

Background and Purpose— Recent data on stroke mortality in diabetics in the United States is lacking. We investigated trends in diabetes prevalence and stroke morality among diabetics in a large veteran cohort. Methods— The Patient Treatment File was used to identify all patients discharged from any Veterans hospital between October 1990 and September 1997 with a diagnosis of ischemic stroke (ICD-9-CM codes 434, 436) listed as primary diagnosis. Demographic, morbidity, and mortality data were recorded. Chi-square tests were used to examine differences between diabetics and nondiabetics, and t tests were used for continuous variables. Cox proportional hazards regression was used to examine the effects of diabetes (DM) on the survival times controlling for multiple covariates. Results— Of 48 733 ischemic stroke patients identified, 98% were male and 13 925 (25%) had DM. Mean age was similar between DM and non-DM (67.2 versus 67.5, P =NS). Prevalence of DM among stroke subjects increased from 25% to 31%. Charlson index >2 was much higher in DM (68.2% versus 47.9%, P P =NS; 12.6 versus 13.1, P =NS). Kaplan-Meier survival plot showed that DM had shorter long term survival time (log-rank, P P Conclusion— Despite greater comorbidity, postacute ischemic stroke mortality at 60 days and 1 year is not different between subjects with and without DM. Long term mortality after stroke is much lower among DM than that reported in older studies.