The effect of diabetes on outcomes of patients with advanced heart failure in the BEST trial

Michael Domanski, Heidi Krause-Steinrauf, Prakash Deedwania, Dean Follmann, Jalal K. Ghali, Edward Gilbert, Steven Haffner, Richard Katz, Jo Ann Lindenfeld, Brian D Lowes, Wade Martin, Frank McGrew, Michael R. Bristow

Research output: Contribution to journalArticle

168 Citations (Scopus)

Abstract

OBJECTIVES: This was a retrospective analysis to determine the effect of diabetes on outcome in patients with advanced heart failure (HF), and to determine the effect of beta-blockade in patients with HF with and without diabetes mellitus. BACKGROUND: In chronic HF the impact on clinical outcomes and therapeutic response of the prevalent comorbid condition diabetes mellitus has not been extensively investigated. METHODS: We assessed the impact of diabetes on prognosis and effectiveness of beta-blocker therapy with bucindolol in patients with HF enrolled in the Beta-Blocker Evaluation of Survival Trial (BEST). We conducted a retrospective analysis to examine the prognosis of patients with advanced HF with and without diabetes, and the effect of beta-blocker therapy on mortality and HF progression or myocardial infarction (MI). The database was the 2,708 patients with advanced HF (36% with diabetes and 64% without diabetes) who were randomized to the beta-blocker bucindolol or placebo in BEST and followed for mortality, hospitalization, and MI for an average of two years. RESULTS: Patients with diabetes had more severe chronic HF and more coronary risk factors than patients without diabetes. Diabetes was independently associated with increased mortality in patients with ischemic cardiomyopathy (adjusted hazard ratio 1.33, 95% confidence interval 1.12 to 1.58, p = 0.001), but not in those with a nonischemic etiology (adjusted hazard ratio 0.98, 95% confidence interval 0.74 to 1.30, p = 0.89). Compared with patients without diabetes, in diabetic patients beta-blocker therapy was at least as effective in reducing death or HF hospitalizations, total hospitalizations, HF hospitalizations, and MI. Ventricular function and physiologic responses to beta-blockade were similar in patients with and without diabetes. CONCLUSIONS: Diabetes worsens prognosis in patients with advanced HF, but this worsening appears to be limited to patients with ischemic cardiomyopathy. In advanced HF beta-blockade is effective in reducing major clinical end points in patients with and without diabetes.

Original languageEnglish (US)
Pages (from-to)914-922
Number of pages9
JournalJournal of the American College of Cardiology
Volume42
Issue number5
DOIs
StatePublished - Sep 3 2003

Fingerprint

Heart Failure
Survival
Hospitalization
Myocardial Infarction
Cardiomyopathies
Mortality
Diabetes Mellitus
Confidence Intervals
Ventricular Function
Therapeutics
Placebos
Databases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Domanski, M., Krause-Steinrauf, H., Deedwania, P., Follmann, D., Ghali, J. K., Gilbert, E., ... Bristow, M. R. (2003). The effect of diabetes on outcomes of patients with advanced heart failure in the BEST trial. Journal of the American College of Cardiology, 42(5), 914-922. https://doi.org/10.1016/S0735-1097(03)00856-8

The effect of diabetes on outcomes of patients with advanced heart failure in the BEST trial. / Domanski, Michael; Krause-Steinrauf, Heidi; Deedwania, Prakash; Follmann, Dean; Ghali, Jalal K.; Gilbert, Edward; Haffner, Steven; Katz, Richard; Lindenfeld, Jo Ann; Lowes, Brian D; Martin, Wade; McGrew, Frank; Bristow, Michael R.

In: Journal of the American College of Cardiology, Vol. 42, No. 5, 03.09.2003, p. 914-922.

Research output: Contribution to journalArticle

Domanski, M, Krause-Steinrauf, H, Deedwania, P, Follmann, D, Ghali, JK, Gilbert, E, Haffner, S, Katz, R, Lindenfeld, JA, Lowes, BD, Martin, W, McGrew, F & Bristow, MR 2003, 'The effect of diabetes on outcomes of patients with advanced heart failure in the BEST trial', Journal of the American College of Cardiology, vol. 42, no. 5, pp. 914-922. https://doi.org/10.1016/S0735-1097(03)00856-8
Domanski, Michael ; Krause-Steinrauf, Heidi ; Deedwania, Prakash ; Follmann, Dean ; Ghali, Jalal K. ; Gilbert, Edward ; Haffner, Steven ; Katz, Richard ; Lindenfeld, Jo Ann ; Lowes, Brian D ; Martin, Wade ; McGrew, Frank ; Bristow, Michael R. / The effect of diabetes on outcomes of patients with advanced heart failure in the BEST trial. In: Journal of the American College of Cardiology. 2003 ; Vol. 42, No. 5. pp. 914-922.
@article{559b11b68a514b4db3707b254ff8260b,
title = "The effect of diabetes on outcomes of patients with advanced heart failure in the BEST trial",
abstract = "OBJECTIVES: This was a retrospective analysis to determine the effect of diabetes on outcome in patients with advanced heart failure (HF), and to determine the effect of beta-blockade in patients with HF with and without diabetes mellitus. BACKGROUND: In chronic HF the impact on clinical outcomes and therapeutic response of the prevalent comorbid condition diabetes mellitus has not been extensively investigated. METHODS: We assessed the impact of diabetes on prognosis and effectiveness of beta-blocker therapy with bucindolol in patients with HF enrolled in the Beta-Blocker Evaluation of Survival Trial (BEST). We conducted a retrospective analysis to examine the prognosis of patients with advanced HF with and without diabetes, and the effect of beta-blocker therapy on mortality and HF progression or myocardial infarction (MI). The database was the 2,708 patients with advanced HF (36{\%} with diabetes and 64{\%} without diabetes) who were randomized to the beta-blocker bucindolol or placebo in BEST and followed for mortality, hospitalization, and MI for an average of two years. RESULTS: Patients with diabetes had more severe chronic HF and more coronary risk factors than patients without diabetes. Diabetes was independently associated with increased mortality in patients with ischemic cardiomyopathy (adjusted hazard ratio 1.33, 95{\%} confidence interval 1.12 to 1.58, p = 0.001), but not in those with a nonischemic etiology (adjusted hazard ratio 0.98, 95{\%} confidence interval 0.74 to 1.30, p = 0.89). Compared with patients without diabetes, in diabetic patients beta-blocker therapy was at least as effective in reducing death or HF hospitalizations, total hospitalizations, HF hospitalizations, and MI. Ventricular function and physiologic responses to beta-blockade were similar in patients with and without diabetes. CONCLUSIONS: Diabetes worsens prognosis in patients with advanced HF, but this worsening appears to be limited to patients with ischemic cardiomyopathy. In advanced HF beta-blockade is effective in reducing major clinical end points in patients with and without diabetes.",
author = "Michael Domanski and Heidi Krause-Steinrauf and Prakash Deedwania and Dean Follmann and Ghali, {Jalal K.} and Edward Gilbert and Steven Haffner and Richard Katz and Lindenfeld, {Jo Ann} and Lowes, {Brian D} and Wade Martin and Frank McGrew and Bristow, {Michael R.}",
year = "2003",
month = "9",
day = "3",
doi = "10.1016/S0735-1097(03)00856-8",
language = "English (US)",
volume = "42",
pages = "914--922",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - The effect of diabetes on outcomes of patients with advanced heart failure in the BEST trial

AU - Domanski, Michael

AU - Krause-Steinrauf, Heidi

AU - Deedwania, Prakash

AU - Follmann, Dean

AU - Ghali, Jalal K.

AU - Gilbert, Edward

AU - Haffner, Steven

AU - Katz, Richard

AU - Lindenfeld, Jo Ann

AU - Lowes, Brian D

AU - Martin, Wade

AU - McGrew, Frank

AU - Bristow, Michael R.

PY - 2003/9/3

Y1 - 2003/9/3

N2 - OBJECTIVES: This was a retrospective analysis to determine the effect of diabetes on outcome in patients with advanced heart failure (HF), and to determine the effect of beta-blockade in patients with HF with and without diabetes mellitus. BACKGROUND: In chronic HF the impact on clinical outcomes and therapeutic response of the prevalent comorbid condition diabetes mellitus has not been extensively investigated. METHODS: We assessed the impact of diabetes on prognosis and effectiveness of beta-blocker therapy with bucindolol in patients with HF enrolled in the Beta-Blocker Evaluation of Survival Trial (BEST). We conducted a retrospective analysis to examine the prognosis of patients with advanced HF with and without diabetes, and the effect of beta-blocker therapy on mortality and HF progression or myocardial infarction (MI). The database was the 2,708 patients with advanced HF (36% with diabetes and 64% without diabetes) who were randomized to the beta-blocker bucindolol or placebo in BEST and followed for mortality, hospitalization, and MI for an average of two years. RESULTS: Patients with diabetes had more severe chronic HF and more coronary risk factors than patients without diabetes. Diabetes was independently associated with increased mortality in patients with ischemic cardiomyopathy (adjusted hazard ratio 1.33, 95% confidence interval 1.12 to 1.58, p = 0.001), but not in those with a nonischemic etiology (adjusted hazard ratio 0.98, 95% confidence interval 0.74 to 1.30, p = 0.89). Compared with patients without diabetes, in diabetic patients beta-blocker therapy was at least as effective in reducing death or HF hospitalizations, total hospitalizations, HF hospitalizations, and MI. Ventricular function and physiologic responses to beta-blockade were similar in patients with and without diabetes. CONCLUSIONS: Diabetes worsens prognosis in patients with advanced HF, but this worsening appears to be limited to patients with ischemic cardiomyopathy. In advanced HF beta-blockade is effective in reducing major clinical end points in patients with and without diabetes.

AB - OBJECTIVES: This was a retrospective analysis to determine the effect of diabetes on outcome in patients with advanced heart failure (HF), and to determine the effect of beta-blockade in patients with HF with and without diabetes mellitus. BACKGROUND: In chronic HF the impact on clinical outcomes and therapeutic response of the prevalent comorbid condition diabetes mellitus has not been extensively investigated. METHODS: We assessed the impact of diabetes on prognosis and effectiveness of beta-blocker therapy with bucindolol in patients with HF enrolled in the Beta-Blocker Evaluation of Survival Trial (BEST). We conducted a retrospective analysis to examine the prognosis of patients with advanced HF with and without diabetes, and the effect of beta-blocker therapy on mortality and HF progression or myocardial infarction (MI). The database was the 2,708 patients with advanced HF (36% with diabetes and 64% without diabetes) who were randomized to the beta-blocker bucindolol or placebo in BEST and followed for mortality, hospitalization, and MI for an average of two years. RESULTS: Patients with diabetes had more severe chronic HF and more coronary risk factors than patients without diabetes. Diabetes was independently associated with increased mortality in patients with ischemic cardiomyopathy (adjusted hazard ratio 1.33, 95% confidence interval 1.12 to 1.58, p = 0.001), but not in those with a nonischemic etiology (adjusted hazard ratio 0.98, 95% confidence interval 0.74 to 1.30, p = 0.89). Compared with patients without diabetes, in diabetic patients beta-blocker therapy was at least as effective in reducing death or HF hospitalizations, total hospitalizations, HF hospitalizations, and MI. Ventricular function and physiologic responses to beta-blockade were similar in patients with and without diabetes. CONCLUSIONS: Diabetes worsens prognosis in patients with advanced HF, but this worsening appears to be limited to patients with ischemic cardiomyopathy. In advanced HF beta-blockade is effective in reducing major clinical end points in patients with and without diabetes.

UR - http://www.scopus.com/inward/record.url?scp=0041363299&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0041363299&partnerID=8YFLogxK

U2 - 10.1016/S0735-1097(03)00856-8

DO - 10.1016/S0735-1097(03)00856-8

M3 - Article

VL - 42

SP - 914

EP - 922

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 5

ER -