AJM Theme Issue: CardiologyClinical research studyDiabetes in Heart Failure: Prevalence and Impact on Outcome in the Population
Section snippets
Study Setting
This study was conducted in Olmsted County, Minnesota. Epidemiologic studies in Olmsted County are possible because the county is relatively isolated, and only a few providers deliver nearly all health care to local residents. Health care providers in Olmsted County include the Mayo Clinic, Olmsted Medical Center, and a handful of private practitioners. Each medical provider uses a comprehensive medical record system in which the details of every encounter are entered and can be easily
Baseline Characteristics
Six hundred fifty-five subjects with confirmed incident HF between 1979 and 1999 were included in the study. The mean age of the cohort was 77 ± 12 years (mean ± SD), 46% were men, 20% had diabetes, and 38% had clinical CAD.
Forty-two percent of patients were diagnosed in the outpatient setting. Those diagnosed in the hospital had a lower BMI (P = .01) and creatinine clearance (P <.001). They were more likely to have comorbidities (P = .005) and clinical CAD (P <.001).
There were several differences in
Discussion
Over the past 2 decades, the prevalence of DM within a community-based cohort of subjects with HF increased markedly, independently of BMI. This increase was particularly large among older subjects, who form the majority of subjects with HF, further underscoring the growing burden of DM within HF, a disease itself of epidemic proportions.
DM was associated with a large increase in the risk of death after HF, independent of age, sex, creatinine clearance, comorbidity, ejection fraction, and year
Conclusion
Among community-dwelling subjects who present with HF, the prevalence of DM is high and has increased markedly over time independently of BMI, particularly among older subjects. DM is associated with a large increase in the risk of death, independently of age, sex, BMI, renal function, comorbidity, ejection fraction, and year of HF. This risk is modulated by the presence or absence of clinical CAD; the risk of death related to DM after HF diagnosis is the highest when CAD is not clinically
Acknowledgment
We thank Kay A. Traverse, RN and Diane M. Tri, RN for assistance with data collection, and Ryan A. Meverden, BS for assistance with data analysis.
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