Effect of insulin on readmission for heart failure following a hospitalization for acute heart failure
Bertomeu-González, Vicente (Hospital Universitario San Juan de Alicante)
Facila Rubio, Lorenzo (Hospital General Universitario de Valencia)
Palau, Patricia (Universitat de València)
Miñana, Gema (Hospital Clínic Universitari (València))
Núñez, Gonzalo (Hospital Clínic Universitari (València))
De la Espriella, Rafael (Hospital Clínic Universitari (València))
Santas, Enrique (Hospital Clínic Universitari (València))
Núñez, Eduardo (Hospital Clínic Universitari (València))
Bodi, Vicente (Universitat de València)
Chorro, Francisco J. (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Cordero, Alberto (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Sanchis, Juan (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Lupón, Josep (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Bayés-Genís, Antoni (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Núñez, Julio (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Universitat Autònoma de Barcelona

Fecha:	2020
Resumen:	Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and is related with worse outcomes. Insulin treatment is associated with sodium and water retention, weight gain, and hypoglycaemia-all pathophysiological mechanisms related to HF decompensation. This study aimed to evaluate the association between insulin treatment and the risk of 1 year readmission for HF in patients discharged for acute HF. We prospectively included 2895 consecutive patients discharged after an episode of acute HF in a single tertiary hospital. Multivariable Cox regression, adapted for competing events, was used to assess the association between insulin treatment and 1 year readmission for HF in patients discharged after acute HF. Participants' mean age was 73. 4 ± 11. 2 years, 50. 8% were women, 44. 7% had T2DM [including 527 (18. 2%) on insulin therapy], and 52. 7% had preserved ejection fraction. At 1 year follow-up, 518 (17. 9%) patients had died and 693 (23. 9%) were readmitted for HF. The crude risk of readmission for HF was higher in patients on insulin, with no differences in 1 year mortality. After multivariable adjustment, patients on insulin were at significantly higher risk of 1 year readmission for HF than patients with diabetes who were not on insulin (hazard ratio 1. 28; 95% confidence interval 1. 04-1. 59, P = 0. 022) and patients without diabetes (hazard ratio 1. 26; 95% confidence interval 1. 02-1. 55, P = 0. 035). Following acute HF, patients with T2DM on insulin therapy are at increased risk of readmission for HF. Further studies unravelling the mechanisms behind this association are warranted.
Ayudas:	Ministerio de Economía y Competitividad PIE15/00013 Ministerio de Economía y Competitividad CB16/11/00420 Ministerio de Economía y Competitividad CB16/11/00403
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Insulin therapy ; Type 2 diabetes mellitus ; Acute heart failure ; Hospital readmission
Publicado en:	ESC Heart Failure, Vol. 7 (august 2020) , p. 3320-3328, ISSN 2055-5822

DOI: 10.1002/ehf2.12944
PMID: 32790113

9 p, 2.0 MB

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Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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