Abstract 2394: Metformin Therapy in Advanced, Systolic Heart Failure Patients with Diabetes is Associated with Improved Survival and Improved Cardiac Function
Approximately 25% of patients (pts) with heart failure (HF) have diabetes (DM), yet the optimal anti-DM regimen in pts with systolic HF (SHF) is uncertain. Symptomatic HF has been considered a contraindication to Metformin (Met) Rx. We sought to investigate the effect of Met Rx on outcomes in a cohort of advanced, SHF pts with DM. 401 DM pts with advanced, SHF (LVEF = < 40%) were followed at a single university HF center from 1994–2008. The cohort was divided into two groups: Met Rx and No Met Rx. The cohort had a mean age of 56 ± 11yrs, LVEF 24 ± 7%, and 42% were NYHA III, 45% NYHA IV. Twenty-five% (n = 99) were on Met Rx. The two groups were similar in age, sex, baseline EF, medical hx, and baseline HgbA1c. Met Rx pts had a higher BMI (29.2 vs 27.7), better renal function (serum creatinine 1.2 vs 1.6 mg/dL), and were less often on insulin (11 vs 52%). One-yr survival in Met Rx and No Met Rx was 91 and 76%, respectively (RR = 0.37, CI 0.18 – 0.76, p = 0.007). One-yr survival free from death/urgent transplant (tx) in Met Rx and No Met Rx was 84 and 67%, respectively (RR = 0.43, CI 0.25– 0.76, p = 0.004). Adjusted for age, sex, LVEF, and renal function, the RR of all cause mortality and the combined endpoint of death/urgent tx for Met Rx was 0.41 (CI 0.20 – 0.87, p = 0.02) and 0.48 (CI 0.27– 0.84, p = 0.01), respectively. At 6-month f/u, increase in LVEF for Met Rx was 6% vs 3% in No Met Rx. At 6-month f/u, 64% of Met Rx compared to 48% of No Met Rx had an increase in LVEF (p = 0.04). In pts with DM and advanced, SHF, Met Rx was associated with improved survival and improvement in cardiac function. Prospective studies of Met in advanced HF pts with DM are needed to confirm its safety and efficacy in this population.