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Comparative Study
. 2010 Mar;16(3):200-6.
doi: 10.1016/j.cardfail.2009.10.022. Epub 2009 Nov 14.

Metformin therapy and outcomes in patients with advanced systolic heart failure and diabetes

Digish D Shah  1 , Gregg C Fonarow, Tamara B Horwich
Affiliations
Comparative Study

Metformin therapy and outcomes in patients with advanced systolic heart failure and diabetes

Digish D Shah et al. J Card Fail. 2010 Mar.

Abstract

Background: Although 25% to 44% of patients with heart failure (HF) have diabetes mellitus (DM), the optimal treatment regimen for HF patients with DM is uncertain. We investigated the association between metformin therapy and outcomes in a cohort of advanced, systolic HF patients with DM.

Methods and results: Patients with DM and advanced, systolic HF (n = 401) were followed at a single university HF center between 1994 and 2008. The cohort was divided into 2 groups based on the presence or absence of metformin therapy. The cohort had a mean age of 56 +/- 11 years, left ventricular ejection fraction (LVEF) of 24 +/- 7%, with 42% being New York Heart Association (NYHA) III and 45% NYHA IV. Twenty-five percent (n = 99) were treated with metformin therapy. The groups treated and not treated with metformin were similar in terms of age, sex, baseline LVEF, medical history, and baseline glycosylated hemoglobin. Metformin-treated patients had a higher body mass index, lower creatinine, and were less often on insulin. One-year survival in metformin-treated and non-metformin-treated patients was 91% and 76%, respectively (RR = 0.37, CI 0.18-0.76, P = .007). After multivariate adjustment for demographics, cardiac function, renal function, and HF medications, metformin therapy was associated with a nonsignificant trend for improved survival.

Conclusion: In patients with DM and advanced, systolic HF who are closely monitored, metformin therapy appears to be safe. Prospective studies are needed to determine whether metformin can improve HF outcome.

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Figures

Fig. 1
Fig. 1
Metformin and outcomes over 2-year follow-up. (A) 2-year survival, (B) 2-year survival free from death or urgent heart transplant
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