Role of comorbidities and weight variations in the survival of diabetic patients with heart failure

Abstract Objective Heart failure (HF) carries a worse prognosis in patients with diabetes due to various mechanisms, including associated myocardial alterations and potentially greater body weight fluctuations. This study aimed to analyze the influence of diabetes, comorbid conditions and weight variations on survival in a large population of HF patients enrolled in a telemonitoring program. Patients and Methods The study included 16,686 HF patients participating in the Satelia Cardio remote monitoring program for the prevention of HF decompensations, of whom 28.3% were diabetic. The etiologies of HF and major comorbidities were documented. Weight variations were analyzed over fixed and repeated periods of 10 consecutive days. Results Both diabetic and non-diabetic patients had a mean age of 75 years. Among patients with diabetes, the proportion of males was higher (69.4% vs. 61.8%), HF was more severe (NYHA class III: 31.4% vs. 30.2%; class IV: 3.5% vs. 3.2%), and the origin was more frequently ischemic (53.8% vs. 37.8%), with fewer cases due to rhythm disorders, valvular disease, or dilated cardiomyopathy. Comorbidities such as hypertension, obesity, renal failure, chronic obstructive pulmonary disease (COPD), and sleep apnea syndrome (SAS) were significantly more prevalent in patients with diabetes; 54% had four or more comorbidities compared to 15% in those free of diabetes. Patients with diabetes also exhibited greater weight variations. During an average follow-up of 15 months, 2,266 deaths occurred. Among patients with diabetes, survival probability was lower in those with COPD+SAS (p=0.002) or hypertension (p=0.006). Survival probability was lower in patients with diabetes compared to patients without diabetes when one or two HF etiologies were present (p=0.001). Cox regression analysis identified diabetes, male gender, number of HF etiologies, COPD+SAS, NYHA class, and large weight variations as independent predictors of mortality. Conclusion HF patients with diabetes present with a higher burden of comorbidities. Their increased risk of death, especially when HF resulted from one or two etiologies, suggests the role of associated myocardial alterations. Additionally, weight variations hold prognostic value in this population.