Risk Factors and Complications Associated With Diabetes Mellitus in Patients With Heart Failure: a Case-control Study.
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Date
2022Author
Mutai, Caroline, C
Type
ThesisLanguage
enMetadata
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Introduction
Globally, heart failure (HF) is among the leading causes of morbidity and mortality within the
spectrum of adults with cardiovascular diseases. Its prevalence has been said to sharply increase
in the western population, 10% of 75-year-old and above have HF, which is an increase from 1%
in 40-year-old. It is responsible for about 30% of all hospital admission in Sub-Saharan Africa
and 7% in general areas. Heart failure (HF) patients have a higher probability of having preexisting
co-morbidities or developing concomitant diseases such as diabetes mellitus (DM),
predominantly type 2 diabetes. These patients face a substantial risk of in-hospital mortality and
re-hospitalization. DM, majorly type 2 diabetes, affects nearly 390 million people worldwide,
which is expected to increase. Majority of the patients suffering from HF have DM. This close
relationship to some extent is because of commonality of some of the risk factors for HF, such as
hypertension, obesity, sleep apnea, advanced age, and dyslipidemia, are also found in patients
with DM. Research done on this topic was done nearly 20 years ago and therefore there is
paucity of data.
Objective: To determine the risk factors and complications associated with DM in HF patients
Methodology: This was a case control study based in Nairobi County, at the Heart Clinic and
Diabetes clinic in Aga Khan University Hospital Nairobi (AKUHN). All patients with HF with
an EF of ≤ 40% and DM (a fasting blood glucose of >7.5mmol/l and HbA1c of >6.5 mmol/l)
were included in the study. Data collection was undertaken after approval from the Kenyatta
National Hospital/UoN-Ethics and Research Committee (KNH/UoN-ERC) and NACOSTI.
Recruitment of participants into the study was done using a systemic random sampling with the
first participant chosen randomly. Once a case was chosen, a control within five years the age of
the case was chosen. The controls are age-matched individuals with HFrEF without DM.
Collection of data was done using a structured questionnaire and secondary data was collected
from both electronic and medical records. Questions were checked for completeness and were
entered into MS excel ready for analysis. Data was then analyzed using R and R-studio.
Associations were assessed using the odds ratio (OR) and statistically significant findings were
considered significant at a p-value of <0.05.
Results: A total of 377 participants were recruited into the study, 143 cases and 234 controls. In
social demographic findings, the mean age for the entire population with HF was 59.1 years with
an SD of 11.17. The median age was 61 years. In the whole population, there were 29.4% and
30.3% of women in the case and control groups respectively. Among the cases and control
group, men and women comprised 70.6% and 69.7%, respectively. In univariable analysis, there
was no statistically significant association between sex and ethnicity with DM (P-0.842 and P-
0.567) respectively. Obesity was determined by BMI and was categorized into underweight,
normal weight, overweight and obese. Being underweight had a positive non-statistically
significant association with DM (p-value = 0.152). Level of Education, hypertension, Heart
attack, CAD, Holter, myocardial perfusion tests, ischemic cardiomyopathy, non-ischaemic
cardiomyopathy, anaemia and peripartum cardiomyopathy were associated with the onset of DM
among HF patients with a p value of less than 0.20 (P-0.20). In multivariable analysis, those who
were hypertensive had approximately three times the odds of developing DM among HF patients
at an adjusted odds ratio of (aOR – 2.78 95% CI: 1.73-4.46). Heart attack and CAD were not
statistically significantly associated with DM (aOR-1.22, 95% CI: 0.65-2.28) and (aOR-1.17
95% CI: 0.66-2.08) respectively. Those who had ischemic cardiomyopathy were not likely to
develop DM (aOR-1.13, 95% CI: 0.71-1.81) while peripartum cardiomyopathy and atrial
fibrillation showed a statistically significant association with DM (aOR-0.12, 95% CI: 0.01-0.99)
(aOR- 0.08 95% CI: 0.01-0.68) respectively.
Conclusion: DM patients are twice as likely to develop microvascular and macrovascular
complications compared to non-DM patients. Hypertension, Atrial Fibrillation, Peripartum
cardiomyopathy were identified as some of the complications of DM in HF Patients. Therefore,
DM patients should undergo regular screening for these complications and early interventions be
carried out.
Recommendation: Further investigation to be carried out with a larger population in order to
determine the strength of association of the risk factors and complications of DM in HF patients.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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