Influence of Diabetes on Cardiac Resynchronization Therapy With or Without Defibrillator in Patients With Advanced Heart Failure

Jalal k. Ghali, John Boehmer, Arthur M. Feldman, Leslie A. Saxon, Teresa Demarco, Peter Carson, Patrick Yong, Elizabeth G. Galle, Jill Leigh, Fred L. Ecklund, Michael R. Bristow

Research output: Contribution to journalReview article

28 Citations (Scopus)

Abstract

Objectives: We performed a post hoc analysis to determine the influence of cardiac resynchronization therapy with a defibrillator (CRT-D) or without a defibrillator (CRT-P) on outcomes among diabetic patients with advanced heart failure (HF). Background: In patients with systolic HF, diabetes is an independent predictor of morbidity and mortality. No data are available on its impact on CRT-D or CRT-P in advanced HF. Methods: The database of the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure trial was examined to determine the influence of CRT (CRT-D and CRT-P) on outcomes among diabetic patients. All-cause mortality or hospitalization, all-cause mortality or cardiovascular hospitalization, all-cause mortality or HF hospitalization, and all-cause mortality were analyzed among diabetic patients (n = 622). A Cox proportional hazard model, adjusting for age, gender, New York Heart Association, ischemic status, body mass index, left ventricular ejection fraction, heart rate, QRS, left or right bundle branch block, blood pressure, comorbidities (renal failure, carotid artery disease, peripheral vascular disease, hypertension, coronary artery bypass grafting, and atrial fibrillation), medications, and device (with or without defibrillator), was used to estimate hazard ratios (HRs) and significance. Results: The overall outcome of diabetic patients was similar to that of nondiabetic patients in the optimal pharmacologic therapy arm. With CRT, diabetic patients experienced a substantial reduction in all-cause mortality or all-cause hospitalization (HR = 0.77, 95% confidence interval [CI] 62-0.97), all-cause mortality or cardiovascular hospitalization (HR = 0.67, 95% CI 0.53-0.85), all-cause mortality or HF hospitalization (HR = 0.52, 95% CI 0.40-0.69), and all-cause mortality (HR = 0.67, 95% CI 0.45-0.99) compared with optimal pharmacologic therapy. Procedure-related complications and length of stay were identical in diabetic and nondiabetic patients. Conclusion: In diabetic patients with advanced HF, there is a substantial benefit from device therapy with significant improvement in all end points.

Original languageEnglish (US)
Pages (from-to)769-773
Number of pages5
JournalJournal of Cardiac Failure
Volume13
Issue number9
DOIs
StatePublished - Nov 1 2007

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Cardiac Resynchronization Therapy
Defibrillators
Heart Failure
Mortality
Hospitalization
Confidence Intervals
Bundle-Branch Block
Systolic Heart Failure
Equipment and Supplies
Carotid Artery Diseases
Peripheral Vascular Diseases
Therapeutics
Proportional Hazards Models
Coronary Artery Bypass
Stroke Volume
Atrial Fibrillation
Renal Insufficiency
Comorbidity
Length of Stay
Body Mass Index

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Ghali, Jalal k. ; Boehmer, John ; Feldman, Arthur M. ; Saxon, Leslie A. ; Demarco, Teresa ; Carson, Peter ; Yong, Patrick ; Galle, Elizabeth G. ; Leigh, Jill ; Ecklund, Fred L. ; Bristow, Michael R. / Influence of Diabetes on Cardiac Resynchronization Therapy With or Without Defibrillator in Patients With Advanced Heart Failure. In: Journal of Cardiac Failure. 2007 ; Vol. 13, No. 9. pp. 769-773.
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title = "Influence of Diabetes on Cardiac Resynchronization Therapy With or Without Defibrillator in Patients With Advanced Heart Failure",
abstract = "Objectives: We performed a post hoc analysis to determine the influence of cardiac resynchronization therapy with a defibrillator (CRT-D) or without a defibrillator (CRT-P) on outcomes among diabetic patients with advanced heart failure (HF). Background: In patients with systolic HF, diabetes is an independent predictor of morbidity and mortality. No data are available on its impact on CRT-D or CRT-P in advanced HF. Methods: The database of the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure trial was examined to determine the influence of CRT (CRT-D and CRT-P) on outcomes among diabetic patients. All-cause mortality or hospitalization, all-cause mortality or cardiovascular hospitalization, all-cause mortality or HF hospitalization, and all-cause mortality were analyzed among diabetic patients (n = 622). A Cox proportional hazard model, adjusting for age, gender, New York Heart Association, ischemic status, body mass index, left ventricular ejection fraction, heart rate, QRS, left or right bundle branch block, blood pressure, comorbidities (renal failure, carotid artery disease, peripheral vascular disease, hypertension, coronary artery bypass grafting, and atrial fibrillation), medications, and device (with or without defibrillator), was used to estimate hazard ratios (HRs) and significance. Results: The overall outcome of diabetic patients was similar to that of nondiabetic patients in the optimal pharmacologic therapy arm. With CRT, diabetic patients experienced a substantial reduction in all-cause mortality or all-cause hospitalization (HR = 0.77, 95{\%} confidence interval [CI] 62-0.97), all-cause mortality or cardiovascular hospitalization (HR = 0.67, 95{\%} CI 0.53-0.85), all-cause mortality or HF hospitalization (HR = 0.52, 95{\%} CI 0.40-0.69), and all-cause mortality (HR = 0.67, 95{\%} CI 0.45-0.99) compared with optimal pharmacologic therapy. Procedure-related complications and length of stay were identical in diabetic and nondiabetic patients. Conclusion: In diabetic patients with advanced HF, there is a substantial benefit from device therapy with significant improvement in all end points.",
author = "Ghali, {Jalal k.} and John Boehmer and Feldman, {Arthur M.} and Saxon, {Leslie A.} and Teresa Demarco and Peter Carson and Patrick Yong and Galle, {Elizabeth G.} and Jill Leigh and Ecklund, {Fred L.} and Bristow, {Michael R.}",
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Ghali, JK, Boehmer, J, Feldman, AM, Saxon, LA, Demarco, T, Carson, P, Yong, P, Galle, EG, Leigh, J, Ecklund, FL & Bristow, MR 2007, 'Influence of Diabetes on Cardiac Resynchronization Therapy With or Without Defibrillator in Patients With Advanced Heart Failure', Journal of Cardiac Failure, vol. 13, no. 9, pp. 769-773. https://doi.org/10.1016/j.cardfail.2007.06.723

Influence of Diabetes on Cardiac Resynchronization Therapy With or Without Defibrillator in Patients With Advanced Heart Failure. / Ghali, Jalal k.; Boehmer, John; Feldman, Arthur M.; Saxon, Leslie A.; Demarco, Teresa; Carson, Peter; Yong, Patrick; Galle, Elizabeth G.; Leigh, Jill; Ecklund, Fred L.; Bristow, Michael R.

In: Journal of Cardiac Failure, Vol. 13, No. 9, 01.11.2007, p. 769-773.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Influence of Diabetes on Cardiac Resynchronization Therapy With or Without Defibrillator in Patients With Advanced Heart Failure

AU - Ghali, Jalal k.

AU - Boehmer, John

AU - Feldman, Arthur M.

AU - Saxon, Leslie A.

AU - Demarco, Teresa

AU - Carson, Peter

AU - Yong, Patrick

AU - Galle, Elizabeth G.

AU - Leigh, Jill

AU - Ecklund, Fred L.

AU - Bristow, Michael R.

PY - 2007/11/1

Y1 - 2007/11/1

N2 - Objectives: We performed a post hoc analysis to determine the influence of cardiac resynchronization therapy with a defibrillator (CRT-D) or without a defibrillator (CRT-P) on outcomes among diabetic patients with advanced heart failure (HF). Background: In patients with systolic HF, diabetes is an independent predictor of morbidity and mortality. No data are available on its impact on CRT-D or CRT-P in advanced HF. Methods: The database of the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure trial was examined to determine the influence of CRT (CRT-D and CRT-P) on outcomes among diabetic patients. All-cause mortality or hospitalization, all-cause mortality or cardiovascular hospitalization, all-cause mortality or HF hospitalization, and all-cause mortality were analyzed among diabetic patients (n = 622). A Cox proportional hazard model, adjusting for age, gender, New York Heart Association, ischemic status, body mass index, left ventricular ejection fraction, heart rate, QRS, left or right bundle branch block, blood pressure, comorbidities (renal failure, carotid artery disease, peripheral vascular disease, hypertension, coronary artery bypass grafting, and atrial fibrillation), medications, and device (with or without defibrillator), was used to estimate hazard ratios (HRs) and significance. Results: The overall outcome of diabetic patients was similar to that of nondiabetic patients in the optimal pharmacologic therapy arm. With CRT, diabetic patients experienced a substantial reduction in all-cause mortality or all-cause hospitalization (HR = 0.77, 95% confidence interval [CI] 62-0.97), all-cause mortality or cardiovascular hospitalization (HR = 0.67, 95% CI 0.53-0.85), all-cause mortality or HF hospitalization (HR = 0.52, 95% CI 0.40-0.69), and all-cause mortality (HR = 0.67, 95% CI 0.45-0.99) compared with optimal pharmacologic therapy. Procedure-related complications and length of stay were identical in diabetic and nondiabetic patients. Conclusion: In diabetic patients with advanced HF, there is a substantial benefit from device therapy with significant improvement in all end points.

AB - Objectives: We performed a post hoc analysis to determine the influence of cardiac resynchronization therapy with a defibrillator (CRT-D) or without a defibrillator (CRT-P) on outcomes among diabetic patients with advanced heart failure (HF). Background: In patients with systolic HF, diabetes is an independent predictor of morbidity and mortality. No data are available on its impact on CRT-D or CRT-P in advanced HF. Methods: The database of the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure trial was examined to determine the influence of CRT (CRT-D and CRT-P) on outcomes among diabetic patients. All-cause mortality or hospitalization, all-cause mortality or cardiovascular hospitalization, all-cause mortality or HF hospitalization, and all-cause mortality were analyzed among diabetic patients (n = 622). A Cox proportional hazard model, adjusting for age, gender, New York Heart Association, ischemic status, body mass index, left ventricular ejection fraction, heart rate, QRS, left or right bundle branch block, blood pressure, comorbidities (renal failure, carotid artery disease, peripheral vascular disease, hypertension, coronary artery bypass grafting, and atrial fibrillation), medications, and device (with or without defibrillator), was used to estimate hazard ratios (HRs) and significance. Results: The overall outcome of diabetic patients was similar to that of nondiabetic patients in the optimal pharmacologic therapy arm. With CRT, diabetic patients experienced a substantial reduction in all-cause mortality or all-cause hospitalization (HR = 0.77, 95% confidence interval [CI] 62-0.97), all-cause mortality or cardiovascular hospitalization (HR = 0.67, 95% CI 0.53-0.85), all-cause mortality or HF hospitalization (HR = 0.52, 95% CI 0.40-0.69), and all-cause mortality (HR = 0.67, 95% CI 0.45-0.99) compared with optimal pharmacologic therapy. Procedure-related complications and length of stay were identical in diabetic and nondiabetic patients. Conclusion: In diabetic patients with advanced HF, there is a substantial benefit from device therapy with significant improvement in all end points.

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U2 - 10.1016/j.cardfail.2007.06.723

DO - 10.1016/j.cardfail.2007.06.723

M3 - Review article

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JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

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