Impact of Diabetes on Hospitalization for Heart Failure, Cardiovascular Events, and Death: Outcomes at 4 Years from the REACH Registry
Background—Despite the known association of diabetes with cardiovascular events, there are few contemporary data on the long-term outcomes from international cohorts of patients with diabetes. We sought to describe cardiovascular outcomes at 4 years and identify predictors of these events in patients with diabetes.
Methods and Results—The REACH registry is an international registry of patients at high risk of atherothrombosis or established atherothrombosis. Four-year event rates in patients with diabetes were determined using the corrected group prognosis method. Of the 45,224 patients in the REACH registry who had follow-up at 4 years, 43.6% (n=19,699) had diabetes at baseline. The overall risk and hazard rate of cardiovascular death, non-fatal MI, or non-fatal stroke was greater in patients with diabetes compared to patients without (16.5% vs. 13.1%, HRadj 1.27, 95% CI 1.19-1.35). There was also an increase in both cardiovascular death (8.9% vs. 6.0%, HRadj 1.38, 95% CI 1.26-1.52) and overall death (14.3% vs. 9.9%, HRadj 1.40, 95% CI 1.30-1.51). Diabetes was associated with a 33% greater risk of hospitalization for heart failure (9.4% vs. 5.9%, ORadj 1.33, 95% CI 1.18-1.50). In patients with diabetes, heart failure at baseline was independently associated with CV death (HRadj 2.45, 95% CI 2.17-2.77, p<0.001) and hospitalization for heart failure (ORadj 4.72, 95% CI 4.22-5.29, p<0.001).
Conclusions—Diabetes increases substantially the risk of death, ischemic events and heart failure. Patients with both diabetes and heart failure are at particularly elevated risk of cardiovascular death, highlighting the need for additional therapies in this high-risk population.
- Received December 28, 2014.
- Revision received April 1, 2015.
- Accepted June 22, 2015.