Prediction of the adverse course of heart failure of ischemic origin in patients with atrial fibrillation and diabetes mellitus

Objective — to establish predictors of re‑hospitalization (RH) of patients with heart failure (HF) of ischemic origin with concomitant atrial fibrillation (AF) and diabetes mellitus (DM). Materials and methods. We examined 398 patients with HF on the background of post‑infarction cardiosclerosis, including 198 women and 200 men of Caucasian race aged 54 to 67 years (mean 58 years). 226 (56.8%) patients had permanent AF, and 102 (25.6%) had concomitant type 2 diabetes mellitus (DM). 167 (42.0%) patients had a reduced left ventricular ejection fraction (LVEF) ≤40%; 133 (33.4%) patients had moderately reduced LVEF (41—49%); 98 (24.6%) patients had preserved LVEF (≥ 50%). The levels of galectin‑3, ST‑2, brain natriuretic peptide (BNP) and its N‑terminal fragment (NT‑proBNP) were determined. ECG registration, daily ECG monitoring, standardized echocardiographic examination during hospitalization were carried out. During 1 year, the patients were observed, taking into account the presence of repeated hospitalization (RH) due to HF decompensation. Statistical analysis was performed using Statistica and MedCalc programs. Results. HF patients with AF had a higher probability of RH compared to patients with sinus rhythm (SR) (37.9% vs. 26.2%, respectively; odds ratio (OR) 1.76; p=0.0064). The mean time to event development in the group of patients with HF and AF was 9.1±0.3 months, and in the group of patients with HF who had sinus rhythm — 11.0±0.2 months (relative risk (RR) 1.99; p <0.0001). Patients with HF with concomitant DM had a higher probability of RH, compared to patients without DM (68.0% vs. 26.2%, respectively; OR 8.60; p <0.0001). The average time of development of the event in the group with DM was (6.9±0.6) months, against (11.0±0.2) months among patients without diabetes (RR 4.11; p <0.0001). Patients with HF with concomitant DM and AF had a higher probability of RH, compared with HF patients with SR without DM (90.4%, vs. 26.2%, respectively; OR 54.48; p <0.0001). The average time of development of the event in the group of HF patients with a combination of DM and AF was (4.2±0.4) months, against (11.0±0.2) months among patients without diabetes (RR 6.84; p <0.0001). The cumulative risk of RH among patients with HF is the highest with a combination of AF and DM (OR 4.08 (2.47—6.73), p <0.0001). The median time of 50% probability of RH due to HF decompensation in this group was 3.0 (3.0—4.0) months. Conclusions. Comorbidity is associated with a severe course of heart failure. Taking into account the cumulative risk of re‑hospitalization during the year of observation, the combination of diabetes with atrial fibrillation is the most unfavorable (OR 4.08 (2.47—6.73), p <0.0001. Median time 50% probability of re‑hospitalization due to decompensation of heart failure is 3.0 (3.0—4.0) months. According to the logistic regression analysis, the prognostic factors for the course of HF were the functional class of HF according to the New York Heart Association (NYHA) criteria (β=4.61; p <0.0001), a history of diabetes mellitus (β=1.45; p=0.0005), serum galectin‑3 (β=0.52; p=0.0046) and LV EF (β=0.13; p <0.0001).