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CLINICAL RESEARCH: HEART FAILURE

The Impact of Thiazolidinedione Use on Outcomes in Ambulatory Patients With Diabetes Mellitus and Heart Failure

David Aguilar, MD^_*,_*, Biykem Bozkurt, MD, FACC^_*,, Allison Pritchett, MD, FACC^_*, Nancy J. Petersen, PhD and Anita Deswal, MD, MPH, FACC^_*,,

^_* Winters Center for Heart Failure Research and Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.

Manuscript received November 30, 2006; revised manuscript received January 11, 2007, accepted January 16, 2007.

^_* Reprint requests and correspondence: Dr. David Aguilar, Cardiovascular Division, Baylor College of Medicine, 1709 Dryden Street, BCM 620, Suite 500, Box 13, Houston, Texas 77030. (Email: daguilar{at}bcm.edu).

Objectives: This study sought to examine the relationship between thiazolidinedione (TZD) use and outcomes in ambulatory patients with diabetes and heart failure (HF).

Background: Thiazolidinediones have been relatively contraindicated in diabetic patients with HF.

Methods: We conducted a retrospective study of a national cohort of veterans with HF and diabetes treated in ambulatory clinics at Veterans Affairs medical centers. Patients were classified into those using TZDs and those not using insulin-sensitizing medication based on prescriptions filled 90 days before or 30 days after the index outpatient visit. The outcomes were time to hospitalization for HF and time to death.

Results: Of 7,147 ambulatory HF patients receiving diabetic therapy, 818 (11.4%) were receiving a TZD and 4,700 (65.8%) were not receiving insulin sensitizers. Over 2 years of follow-up, 134 (16.4%) patients receiving TZDs and 741 (15.8%) patients not receiving insulin-sensitizing medications required HF hospitalization (adjusted hazard ratio 1.00, 95% confidence interval 0.81 to 1.24, p = 0.97). A total of 168 (20.5%) patients receiving TZDs and 1,192 (25.4%) patients not receiving insulin-sensitizing medications died (adjusted hazard ratio 0.98, 95% confidence interval 0.81 to 1.17, p = 0.80).

Conclusions: In ambulatory patients with established HF and diabetes, the use of TZDs was not associated with an increased risk of HF hospitalization or total mortality when compared with those not receiving insulin-sensitizing medications.

Abbreviations and Acronyms   CI = confidence interval   COPD = chronic obstructive pulmonary disease   EPRP = External Peer Review Program   HF = heart failure   HR = hazard ratio   LVEF = left ventricular ejection fraction   TZD = thiazolidinedione   VA = Veterans Affairs

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