Evidence map›Paper›PMID 31271255›Full record

ArticleEuropean journal of heart failure2019

Insulin treatment and clinical outcomes in patients with diabetes and heart failure with preserved ejection fraction.

Li Shen, Rasmus Rørth, Deborah Cosmi, Søren Lund Kristensen, Mark C Petrie, Franco Cosmi, Roberto Latini, Lars Køber, Inder S Anand, Peter E Carson and 10 more

Open access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European journal of heart failure, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 2 pooled it
7.2field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 2 syntheses or guidelines pooled it, 68 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors at 14 institutions in 9 countries.

Li ShenDepartment of Cardiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Rasmus RørthBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Deborah CosmiDepartment of Cardiology, Hospital of Gubbio, Gubbio, Italy.
Søren Lund KristensenBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Mark C PetrieBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Franco CosmiDepartment of Cardiology, Hospital of Cortona, Cortona, Italy.
Roberto LatiniDepartment of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Lars KøberRigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
Inder S AnandDepartment of Medicine, University of Minnesota Medical School and VA Medical Center, Minneapolis, MN, USA.
Peter E CarsonDepartment of Cardiology, Washington VA Medical Center, Washington, DC, USA.
Christopher B GrangerDuke Clinical Research Institute, Duke University, Durham, NC, USA.
Michel KomajdaDepartment of Cardiology, Hospital Saint Joseph, Paris, France.
Robert S McKelvieWestern University, London, Ontario, Canada.
Scott D SolomonDepartment of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Lidia StaszewskyDepartment of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Karl SwedbergDepartment of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
Thao HuynhMcGill Health University Center, Division of Cardiology, Montreal, Quebec, Canada.
Michael R ZileMedical University of South Carolina and Ralph H. Johnston Veterans Administration Medical Center, Charleston, SC, USA.
Pardeep S JhundBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
John J V McMurrayBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
University of Glasgow · GBMario Negri Institute for Pharmacological Research · ITClinical Research Institute · USCopenhagen University Hospital · DKCork University Hospital · IEHarvard University · USMcGill University · CAMedical University of South Carolina · USMinneapolis VA Medical Center · USSaint Joseph Hospital · USState Administration of Foreign Experts Affairs · CNUniversity of Gothenburg · SEWashington DC VA Medical Center · USWestern University · CA

Funding

British Heart Foundation Centre of Excellence RE/18/6/34217
6 · The paper itself

Abstract

aimsInsulin causes sodium retention and hypoglycaemia and its use is associated with worse outcomes in heart failure (HF) with reduced ejection fraction. We have investigated whether this is also the case in HF with preserved ejection fraction (HFpEF). METHODS AND

resultsWe examined the association between diabetes/diabetes treatments and the risk of the primary composite of cardiovascular death or HF hospitalization, as well as other outcomes in adjusted analyses in CHARM-Preserved (left ventricular ejection fraction ≥ 45%), I-Preserve and TOPCAT (Americas) pooled. Of 8466 patients, 2653 (31%) had diabetes, including 979 (37%) receiving insulin. Patients receiving insulin were younger, had a higher body mass index, prevalence of ischaemic aetiology, N-terminal pro-B-type natriuretic peptide and use of diuretics, worse New York Heart Association class and signs and symptoms, and worse quality of life and renal function, compared to patients with diabetes not on insulin. Among the 1398 patients with echocardiographic data, insulin use was associated with higher left ventricular end-diastolic pressure and more diastolic dysfunction than in other participants. The primary outcome occurred at a rate of 6.3 per 100 patient-years in patients without diabetes, and 10.2 and 17.1 per 100 patient-years in diabetes patients without and with insulin use, respectively [fully adjusted hazard ratio (aHR) insulin-treated diabetes vs. other diabetes: 1.41, 95% confidence interval (CI) 1.23-1.63, P < 0.001]. The adjusted HR is 1.67 (95% CI 1.20-2.32, p = 0.002) for sudden death (insulin-treated diabetes vs. other diabetes).

conclusionsInsulin use is associated with poor outcomes in HFpEF. Although we cannot conclude a causal association, the safety of insulin and alternative glucose-lowering treatments in HF needs to be evaluated in clinical trials.

Indexed as

AgedCause of DeathDiabetes Mellitus, Type 2FemaleGlobal HealthHeart FailureHospitalizationHumansHypoglycemic AgentsInsulinMaleMiddle AgedPrognosisQuality of LifeStroke VolumeSurvival RateHypoglycemic AgentsInsulinDiabetes mellitusHeart failureInsulin

Identifiers

PMID31271255
PMCPMC7079555
OpenAlexW2953451576

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.