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Diabetes significantly increases a patient’s chance of developing heart failure (HF) after acute myocardial infarction (MI) and the combination of HF and diabetes triples the risk of death at five years.
These findings from the FAST-MI study were reported yesterday by Professor Nicolas Danchin (AP-HP – European Hospital Georges Pompidou, Paris, France) in a Late-Breaking Science presentation.
“It is well documented that diabetes is associated with a higher risk of HF in patients with coronary artery disease (CAD),” says Prof. Danchin. “Conversely, we have known little about the impact of diabetes on the risk of HF in patients with acute MI. Given that this could have important treatment implications, we wanted to determine the prognostic value of diabetes on the risk of HF and on mortality in this patient group.”
FAST-MI included patients from three nationwide French surveys, conducted in 2005, 2010 and 2015, following consecutively enrolled patients with non-fatal ST-elevation MI (STEMI) or non-STEMI. Follow-up was one year, with additional follow-up at five years for patients in the 2005 and 2010 surveys who survived for at least one year. Among the 12,473 patients, 24% had diabetes and these patients tended to be older (mean of five years) than those without diabetes. The team looked at endpoints in three populations with and without diabetes: 1) the development of HF during initial hospitalisation in patients without a history of HF; 2) hospitalisation with HF during the first year after an MI in patients discharged from hospital alive with no HF during hospitalisation or at discharge; and 3) death at five years in patients who were alive at one year, according to the occurrence of non-fatal HF during the year following acute MI.“Unadjusted data showed that the risk of developing HF during the initial hospitalisation was 29% among patients with diabetes and 15% among those without diabetes,” says Prof. Danchin. Around 9,000 patients—2,000 with diabetes—did not die or develop HF during the initial hospitalisation. “Within this group, even after adjusting for confounders, such as age and sex, patients with diabetes had a 70% increased risk of being hospitalised for non-fatal HF in the year following MI (adjusted hazard ratio [HR] 1.70; p=0.002),” he continues. Diabetes also increased the risk of death or hospitalisation (adjusted HR 1.60; p<0.001), both for non-insulin-requiring (HR 1.35; p=0.013) and insulin-requiring (HR 2.09; p<0.001) patients.
Among patients who were alive for one year, diabetic patients who had been hospitalised for non-fatal HF during the first year after MI had double the risk of death by five years compared with diabetic patients who had not been hospitalised for HF (HR 2.02; p=0.014). The risks of 5-year mortality were 40% and 14.5%, respectively. Patients without diabetes who were hospitalised for HF during the first year also had a higher risk of death at five years (17.4%), but this was smaller than the risk in diabetic patients with HF. Developing HF requiring hospitalisation in the year following acute MI was associated with a higher absolute risk of death at five years in diabetic patients compared with non-diabetic patients (25.5% vs 10.4%).
“Compared with the reference group of patients suffering an MI who did not have diabetes and did not develop HF within the first year, the development of HF in the first year with no concomitant diabetes increased the risk of 5-year mortality by 33%. The presence of diabetes without HF increased the risk by 44%. However, in patients with diabetes who developed HF during the first year, the risk of 5-year mortality was three-times that of the reference group,” explains Prof. Danchin.
These data shed much-needed light on the impact of diabetes on HF after acute MI. “The results clearly show that patients with a history of diabetes are at a greater risk of developing HF, both at the acute stage and later on after their MI,” says Prof. Danchin. “They also demonstrate that in patients with diabetes, non-fatal HF is strongly associated with an increased mid-term risk of mortality. This is a really important message and underlines the need for improved management strategies to avoid the development of HF in diabetic patients suffering an acute MI.”
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