Abstract 1894: Thiazolidinediones are Not Associated with Increased Risk of Heart Failure Hospitalizations in Ambulatory Patients with Diabetes Mellitus and Heart Failure
Introduction: The use of thiazolidinediones (TZDs) is not recommended for patients with NYHA class III or IV symptoms because these agents may worsen heart failure (HF) signs and symptoms. We examined whether the use of TZDs was associated with a higher risk of hospitalization for HF in ambulatory patients with HF and diabetes compared with patients on other diabetic medications.
Methods: We conducted a retrospective study of a national cohort of 7147 veterans with HF and diabetes treated in ambulatory clinics at Veteran Affairs (VA) medical centers. Individuals were classified into those using TZDs and those using non-insulin sensitizing medications based on prescriptions filled 90 days prior to or 30 days following the index outpatient visit. Individuals receiving biguanides in the absence of TZDs were excluded. The primary outcome was time to hospitalization for HF. The secondary outcome was time to death. Multivariable Cox proportional hazards modeling was used to assess the relationship between drug therapy and the outcomes of interest.
Results: Of the 7147 individuals in the cohort, 818 (11.4%) individuals were receiving a TZD, and 4700 (65.8%) individuals were not receiving insulin sensitizers. 1629 (22.8%) individuals receiving biguanides in the absence of TZDS were excluded. Baseline characteristics of patients in the two groups are shown in the table⇓. During two-year follow up, 134 (16.4%) TZD users and 741 (15.8%) of those not receiving insulin sensitizers required admission for HF (unadjusted p=0.66). The adjusted hazard ratio for HF hospitalization was 1.01 (95% CI 0.82, 1.25) and for death was 0.98 (95% CI 0.81, 1.17) in the TZD users when compared to those not receiving insulin sensitizers.
Conclusions: In an ambulatory cohort of individuals with diabetes and HF, TZDs are used by approximately 1 in 10 patients. Heart failure admission or total mortality were not significantly different in those who used TZDs compared to non-insulin sensitizers.