Mortality risk factors in patients with advanced heart failure and diabetes mellitus

Background: An accurate assessment of prognosis is an important element of the management of patients with advanced heart failure (HF) and diabetes mellitus (DM), due to the particularly unfavourable effect of concomitance of both diseases on their course and treatment efficacy. Aims: The aim of the study was to determine the prognostic factors affecting survival in patients with HF and DM. Methods: A retrospective analysis of clinical and laboratory data of 367 consecutive patients with advanced HF (New York Heart Association class III–IV) and DM, hospitalised in a referral centre for interventional cardiology between 2009 and 2013, was performed. Patients with haematological disorders, treated with steroids or with incomplete clinical data were excluded from the analysis. The endpoint of the study was death from all causes. Results: The average patient age was 63.3 ± 10.8 years, 75.7 % of the patients were male. During a mean follow-up of 4.4 ± 1.3 years, the overall mortality rate was 53.7 %. In a multivariate analysis, independent risk factors of death included atrial fibrillation [Hazard Ratio (HR) 1.5730 (95 % Confidence Interval (CI) 1.1417 - 2.1671)); p < 0.01], red blood cell distribution width (RDW) [HR 1.0492 (95 % CI 1.0247 - 1.0743); p < 0.0001] and platelet-to-lymphocyte ratio (PLR) [HR 1.0045 (95 % CI 1.0032 - 1.0057); p < 0.0001]. Conclusions: Our study showed that permanent atrial fibrillation and two haematological parameters, RDW and PLR, are associated with an increased risk of death in advanced HF patients with concomitant DM in the long-term follow-up.