Incidence of heart failure among diabetic patients with ischemic heart disease: a cohort study

• Type of Material: Article
• Authors: Senbeta Guteta Abdissa, Addis Ababa University; Wakgari Deressa, Addis Ababa University; Amit Shah, Emory University
• Language: English
• Date: 2020-04-19
• Publisher: BMC Publishing
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s). 2020.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12872-020-01457-6
• Title of Journal or Parent Work: BMC Cardiovascular Disorders
• Volume: 20
• Issue: 1
• Start Page: 181
• End Page: 181
• Grant/Funding Information: This work was supported by the Medical Education Partnership Initiative-Ethiopia (MEPI).
• Keywords: Heart failure; Risk factors; Science & Technology; Patterns; Ischemic heart disease; Mortality; Mechanisms; Cardiovascular System & Cardiology; Retrospective cohort study; Impact; Adults; Blood pressure; Cardiac & Cardiovascular Systems; Cardiomyopathy; Diabetes mellitus; Life Sciences & Biomedicine; Incidence; Stroke
• Research Categories: Health Sciences, Public Health; Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

Background: In population studies of heart failure (HF), diabetes has been shown to be an independent risk factor. However, the evidence evaluating diabetes mellitus (DM) as an independent risk factor in incident HF in patients with ischemic heart disease (IHD) is scarce. Our study aimed to assess the incidence of HF in diabetic IHD patients compared to non-diabetic IHD patients in Ethiopia. Methods: A retrospective cohort study was conducted among 306 patients with IHD followed-up at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. The IHD patients who did not have HF at baseline were followed for 24 months beginning from November 30, 2015. We assessed the incidence of HF in patients with diabetic IHD versus the non-diabetic IHD. Cox proportional hazards models were used to assess the association between diabetic IHD and HF after controlling for important covariates. Hypertension was examined as a possible effect modifier as well. Results: The mean age was 56.8 years, 69% were male, and 31% were diabetic. During the 24 months follow-up period, 196 (64.1%) had incident HF. On multivariate Cox regression, DM was significantly associated with incident HF [Hazard Ratio = 2.04, 95% confidence interval (CI): 1.32-3.14, p = 0.001]. Furthermore, when the patients were stratified by hypertension (HTN), DM was associated with worse prognosis, the strongest association being in those with co-existing DM and HTN [HR = 2.57,95% CI =1.66-3.98, p < 0.0001] followed by the presence of DM without HTN [HR 2.27, 95% CI = 1.38-3.71, p = 0.001] (compared to those with neither). Conclusion: DM is the strongest predictor of incident HF, compared to other traditional risk factors, in Ethiopian patients with IHD. Those with both DM and HTN are at the highest risk.