Abstract 3581: The Influence of Diabetes on Outcome with Cardiac Resynchronization Therapy: Results from the COMPANION Trial
Introduction: Diabetes is an independent predictor of morbidity and mortality among heart failure (HF) patients. No data are available, however, on the impact of diabetes on resynchronization therapy with (CRT-D) or without (CRT-P) defibrillator in advanced HF.
Methods: The database of COMPANION trial was examined retrospectively to determine the influence of diabetes on outcome. The primary end point of all cause mortality or hospitalization as well as several outcome measures were analyzed among diabetics (n=622) and non diabetics (n=897). Cox proportional hazard model adjusting for age, gender, NYHA, ischemic status, body mass index, LVEF, systolic blood pressure, heart failure medications and device (CRT with or without ICD) was used to estimate hazard ratios and significance.
Results: The prevalence of diabetes was high (41%). The outcome of diabetics was similar to non-diabetic as shown in the figure⇓. Diabetes was associated with a significant increase in all-cause mortality or HF hospitalization [44% vs. 36% HR 1.22 (95% 1.03–1.45)]. When CRT-P and CRT-D were pooled together and compared to optimal medical management (OPT), there was an overall similar response in diabetics and non-diabetics. A striking decrease in pump failure deaths was noted in diabetics (HR 0.62; 95% 0.20 – 0.86. Comparing OPT to combined CRT-P and CRT-D suggested a more pronounced benefit in diabetics (fig⇓.).
Conclusion: In diabetics with advanced HF, the benefit from device therapy is substantial. There is a need for prospective trial to determine whether diabetes should be a factor favoring the use of device therapy.