METFORMIN IS ASSOCIATED WITH BETTER QUALITY OF LIFE AND OUTCOME IN DIABETIC PATIENTS WITH ADVANCED HEART FAILURE WITH REDUCED EJECTION FRACTION (HFREF): A SINGLE CENTER STUDY

Background: There is insufficient evidence about the role of metformin (MET) for treatment of patients with advanced heart failure with reduced ejection fraction (HFrEF) and diabetes mellitus (DM). We evaluated the impact of MET on metabolic profile, quality of life (QoL) and survival in prospectively followed patients with advanced HFrEF and DM.
Methods: A total of 847 stable advanced HFrEF patients (67.7% NYHA III/IV, LV-ejection fraction 23.59 %) underwent detailed clinical and laboratory characterization during elective hospitalization and were prospectively followed for 1126 (IQRs 410; 1781) days. Adverse outcome was defined as death, urgent heart transplantation or implantation of mechanical circulatory support.
Results: DM patients (380, 44.9%) had significantly worse outcome than DM-free individuals; 70.8% vs. 52.7% patients, respectively, experienced an adverse outcome (p<0.0001). 87 (22.9%) patients with DM were treated with MET. These patients had better QoL assessed by the Minnesota Living with Heart Failure Questionnaire (mean of 36 vs. 48 points, p= 0.002); MET treatment was also significantly associated with QoL in multivariable linear regression (p= 0.007). MET-treated patients with DM (but not patients treated with other agents) had better event-free survival (Fig. 1), which remained significant (p= 0.023) even after adjustment for BNP, BMI and eGFR. Propensity score analysis matching 21 covariates including BMI, eGFR and BNP yielded 73 pairs of patients and showed significantly better survival in the MET-treated subgroup (McNemar p= 0.01, Cox proportional hazard model p=0.033).
Conclusion: MET treatment of patients with advanced HFrEF and DM is associated with better quality of life and improved outcome.
Supported by Ministry of Health of the Czech Republic, grant nr. NV19-02-00130. All rights reserved.