Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure

TY - JOUR

T1 - Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure

AU - Godec, Thomas R.

AU - Bromage, Daniel I.

AU - Pujades-Rodriguez, Mar

AU - Cannatà, Antonio

AU - Gonzalez-Izquierdo, Arturo

AU - Denaxas, Spiros

AU - Hemingway, Harry

AU - Shah, Ajay M.

AU - Yellon, Derek M.

AU - McDonagh, Theresa A.

N1 - Funding Information: D.B. has received funding from a National Institute for Health Research Clinical Lectureship (CL‐2016‐17‐001) and the Academy of Medical Sciences (SGL020\1087). M.P.R. is employed by IQVIA, a research contract organization. H.H. is a National Institute for Health Research (NIHR Senior Investigator). This study is part of the BigData@Heart Consortium that is funded by the Innovative Medicines Initiative‐2 Joint Undertaking (grant agreement 116074). This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA; it is chaired, by DE Grobbee and SD Anker, partnering with 20 academic and industry partners and ESC. This work is supported by Health Data Research UK, which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome. This study was supported by National Institute for Health Research (RP‐PG‐0407‐10314) and Wellcome Trust (086091/Z/08/Z). This study was supported by the Farr Institute of Health Informatics Research at UCL Partners, from the Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institute for Social Care and Health Research, and Wellcome Trust (MR/K006584/1). This paper represents independent research part funded (A.G.I. and S.D.) by the National Institute for Health Research (NIHR) Biomedical Research Centre at University College London Hospitals. Funding Information: D.B. has received funding from a National Institute for Health Research Clinical Lectureship (CL-2016-17-001) and the Academy of Medical Sciences (SGL020\1087). M.P.R. is employed by IQVIA, a research contract organization. H.H. is a National Institute for Health Research (NIHR Senior Investigator). This study is part of the BigData@Heart Consortium that is funded by the Innovative Medicines Initiative-2 Joint Undertaking (grant agreement 116074). This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA; it is chaired, by DE Grobbee and SD Anker, partnering with 20 academic and industry partners and ESC. This work is supported by Health Data Research UK, which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome. This study was supported by National Institute for Health Research (RP-PG-0407-10314) and Wellcome Trust (086091/Z/08/Z). This study was supported by the Farr Institute of Health Informatics Research at UCL Partners, from the Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institute for Social Care and Health Research, and Wellcome Trust (MR/K006584/1). This paper represents independent research part funded (A.G.I. and S.D.) by the National Institute for Health Research (NIHR) Biomedical Research Centre at University College London Hospitals. This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data are provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the author/s alone. HES and ONS Data, Copyright (2021), reused with the permission of The Health & Social Care Information Centre. All rights reserved. The OPCS Classification of Interventions and Procedures, codes, terms and text is Crown copyright (2016) published by Health and Social Care Information Centre, also known as NHS Digital and licensed under the Open Government Licence available at http://www.nationalarchives.gov.uk/doc/open-government-licence/opengovernment-licence.htm This study was carried out as part of the CALIBER programme (https://www.ucl.ac.uk/healthinformatics/caliber). CALIBER, led from the UCL Institute of Health Informatics, is a research resource consisting of anonymized, curated variables extracted from linked electronic health records, methods and tools, specialized infrastructure, and training and support. Publisher Copyright: © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

PY - 2022/6

Y1 - 2022/6

N2 - Aim: The optimal strategy for diabetes control in patients with heart failure (HF) following myocardial infarction (MI) remains unknown. Metformin, a guideline-recommended therapy for patients with chronic HF and type 2 diabetes mellitus (T2DM), is associated with reduced mortality and HF hospitalizations. However, worse outcomes have been reported when used at the time of MI. We compared outcomes of patients with T2DM and HF of ischaemic aetiology according to antidiabetic treatment. Methods and results: This study used linked data from primary care, hospital admissions, and death registries for 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of cardiovascular mortality and HF hospitalization. The secondary endpoints were the individual components of the primary endpoint and all-cause mortality. To evaluate the effect of temporal changes in diabetes treatment, antidiabetic medication was included as time-dependent covariates in survival analyses. The study included 1172 patients with T2DM and prior MI and incident HF between 3 January 1998 and 26 February 2010. Five hundred and ninety-six patients had the primary outcome over median follow-up of 2.53 (IQR: 0.98–4.92) years. Adjusted analyses showed a reduced hazard of the composite endpoint for exposure to all antidiabetic medication with hazard ratios (HRs) of 0.50 [95% confidence interval (CI): 0.42–0.59], 0.66 (95% CI: 0.55–0.80), and 0.53 (95% CI: 0.43–0.65), respectively. A similar effect was seen for all-cause mortality [HRs of 0.43 (95% CI: 0.35–0.52), 0.57 (95% CI: 0.46–0.70), and 0.34 (95% CI: 0.27–0.43), respectively]. Conclusions: When considering changes in antidiabetic treatment over time, all drug classes were associated with reduced risk of cardiovascular mortality and HF hospitalization.

AB - Aim: The optimal strategy for diabetes control in patients with heart failure (HF) following myocardial infarction (MI) remains unknown. Metformin, a guideline-recommended therapy for patients with chronic HF and type 2 diabetes mellitus (T2DM), is associated with reduced mortality and HF hospitalizations. However, worse outcomes have been reported when used at the time of MI. We compared outcomes of patients with T2DM and HF of ischaemic aetiology according to antidiabetic treatment. Methods and results: This study used linked data from primary care, hospital admissions, and death registries for 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of cardiovascular mortality and HF hospitalization. The secondary endpoints were the individual components of the primary endpoint and all-cause mortality. To evaluate the effect of temporal changes in diabetes treatment, antidiabetic medication was included as time-dependent covariates in survival analyses. The study included 1172 patients with T2DM and prior MI and incident HF between 3 January 1998 and 26 February 2010. Five hundred and ninety-six patients had the primary outcome over median follow-up of 2.53 (IQR: 0.98–4.92) years. Adjusted analyses showed a reduced hazard of the composite endpoint for exposure to all antidiabetic medication with hazard ratios (HRs) of 0.50 [95% confidence interval (CI): 0.42–0.59], 0.66 (95% CI: 0.55–0.80), and 0.53 (95% CI: 0.43–0.65), respectively. A similar effect was seen for all-cause mortality [HRs of 0.43 (95% CI: 0.35–0.52), 0.57 (95% CI: 0.46–0.70), and 0.34 (95% CI: 0.27–0.43), respectively]. Conclusions: When considering changes in antidiabetic treatment over time, all drug classes were associated with reduced risk of cardiovascular mortality and HF hospitalization.

KW - Antidiabetic agents

KW - Heart failure

KW - Ischaemic cardiomyopathy

KW - Metformin

KW - Outcomes

KW - Type 2 diabetes

UR - http://www.scopus.com/inward/record.url?scp=85126879419&partnerID=8YFLogxK

U2 - 10.1002/ehf2.13910

DO - 10.1002/ehf2.13910

M3 - Article

AN - SCOPUS:85126879419

SN - 2055-5822

VL - 9

SP - 1608

EP - 1615

JO - ESC Heart Failure

JF - ESC Heart Failure

IS - 3

ER -