Epidemiology of diabetes and heart failure
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Epidemiology of Diabetes and Heart Failure. David McFadden M.D. Mayo Clinic. Heart failure (HF) affects > 5 million persons and is responsible for > 250,000 deaths in the United States annually.

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Epidemiology of diabetes and heart failure

Epidemiology of Diabetes and Heart Failure

David McFadden M.D.

Mayo Clinic


  • Heart failure (HF) affects >5 million persons and is responsible for >250,000 deaths in the United States annually.

  • HF hospitalization rates in the United States increased by nearly 33% from 1990–2004, in contrast to a contemporaneous decrease in hospitalization rates for myocardial infarction of 8%.



Framingham cohort
Framingham cohort increasing prevalence of obesity and diabetes in the United States, it can be expected that the population with diabetes who have HF will also increase.

  • an association between diabetes and the risk for incident HF independent of differences in coexisting CAD or hypertension.

  • the proportion of HF cases in a population accounted for by diabetes alone was 12% in women and 6% in men.


Cardiovascular health study
Cardiovascular Health Study increasing prevalence of obesity and diabetes in the United States, it can be expected that the population with diabetes who have HF will also increase.


  • Diabetes conferred a significantly higher independent risk for incident HF in 5,888 older patients followed for an average of 5.5 years (relative risk [RR], 1.78).

  • The proportion of incident HF in the population due to diabetes was greater than that due to renal dysfunction, electrocardiographic left ventricular hypertrophy, or left ventricular systolic dysfunction .


Kaiser permanente database
Kaiser Permanente database for incident HF in 5,888 older patients followed for an average of 5.5 years (relative risk [RR], 1.78).

  • It corroborated the Framingham and CHS results

  • Strikingly, the prevalence of HF in patients with diabetes in this population exceeded 1 in 9.


In clinical trial populations
In clinical trial populations for incident HF in 5,888 older patients followed for an average of 5.5 years (relative risk [RR], 1.78).

  • Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), which enrolled subjects aged ≥ 55 years with hypertension and ≥1 other cardiovascular risk factor.

  • Davis and colleagues found that patients with diabetes had a nearly 2-fold risk for HF hospitalization or death after adjustment for other risk factors (RR, 1.95).



  • In patients with incident HF in Olmsted County, Minnesota, from 1979 –2000, the prevalence of diabetes was 24%.

  • In a nationally representative sample of Medicare beneficiaries hospitalized with principal discharge diagnosis of HF, Havranek and colleagues found a prevalence of diabetes exceeding 38%.


Diabetes is also a risk factor for the progression of hf
diabetes is also a risk factor for the progression of HF from 1979 –2000, the prevalence of diabetes was


Studies of left ventricular dysfunction solvd trial
Studies of Left Ventricular Dysfunction (SOLVD) trial from 1979 –2000, the prevalence of diabetes was

  • Das and colleagues found that in patients with asymptomatic ischemic cardiomyopathy, diabetes was a risk factor for the development of HF symptoms (hazard ratio [HR], 1.56), HF hospitalization (RR, 2.16), or the composite of death or symptom development (HR, 1.50).

  • This relation was not observed in patients with nonischemic cardiomyopathies.


Diabetes as an important predictor of mortality in patients with hf
diabetes as an important predictor of mortality in patients with HF

  • Several studies, including clinical trials and community-based samples, have identified diabetes as an important predictor of mortality in patients with HF independent of other prognostic factors, including comorbidity and functional status.



Those hospitalized for hf
those hospitalized for HF patients, including those hospitalized for HF, ambulatory patients, those enrolled in clinical trials, and those with and without LVSD.

  • Gustafsson and his colleague did a study which was an analysis of survival data comprising 5,491 patients consecutively hospitalized with new or worsening HF and screened for entry into the Danish Investigations of Arrhythmia and Mortality on Dofetilide (DIAMOND).


Those hospitalized for hf1
those hospitalized for HF patients, including those hospitalized for HF, ambulatory patients, those enrolled in clinical trials, and those with and without LVSD.


Gustafsson et al. patients, including those hospitalized for HF, ambulatory patients, those enrolled in clinical trials, and those with and without LVSD.JACC Vol 43, No 5, 2004; 771-7


Ambulatory patients
ambulatory patients patients, including those hospitalized for HF, ambulatory patients, those enrolled in clinical trials, and those with and without LVSD.

  • All patients with HF and left ventricular systolic dysfunction attending the outpatient clinic at our Veteran’s Hospital between October 1999 and November 2000 were enrolled in our study and followed prospectively. Electronic medical records were accessed for data on comorbid conditions, medications, echocardiogram results and mortality information. Mean follow-up was 2.7 years.





Thank you! with a higher rate of adverse outcomes from HF.


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