The Impact of Diabetes and Comorbidities on the Outcome of Heart Failure Patients Treated With Cardiac Resynchronization Therapy
Implications for Patient Management
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- cardiac resynchronization therapy
- diabetes mellitus
- heart failure
- renal insufficiency, chronic
Heart failure (HF) affects 1% to 2% of the population in developed countries, with a marked rise of its prevalence in subjects aged >70 years1. It has been estimated that ≈15 of 900 million Europeans and ≈5.7 of 300 million US Americans may present HF.1,2 It is worrisome to consider that the prevalence of HF is expected to further increase, as a result of the increasing aging of the population.
See Article by Echouffo-Tcheugui et al
HF is a major driver of morbidity for affected patients and of costs for healthcare systems. It has been reported that there are >1 million hospitalizations for HF annually in both the United States and Europe.2 This burden is also related to the high risk of rehospitalization because after discharge, the 3-month rate for death and readmission is close to 17% and 32%, respectively.3 The outcome of patients affected by HF is generally poor, with a 1-year occurrence of the combined end point of mortality or HF hospitalization of 36% for acute HF and of 14.5% for chronic HF4. At 5 years, the survival rate of patients with HF is close to 50%, and it is, therefore, worse than that of the most common cases of diagnosed cancer.5 With this epidemiological profile, the consequent financial burden is impressive: the costs for HF-related care can come to ≈$40 billion each year.2
Comorbidities are important in the management and the outcome of patients with HF1. The majority of patients with HF enrolled in the EORP-HF registry (Eurobservational Research Programme –Heart Failure Pilot; 74%) had at least 1 comorbidity, the most prevalent being chronic kidney disease (CKD; 41%), anemia (29%), and diabetes mellitus (29%). Co-morbidities were independently associated with higher age, higher New York …