This sub-analysis demonstrates substantial differences regarding both baseline features and in-hospital outcome among diabetic and non-diabetic AHF patients. Diabetic patients (n = 2229, 45%) presented more frequently with acute pulmonary edema (p < 0.001) than non-diabetics, had more often acute coronary syndrome (p < 0.001) as precipitating factors of AHF, and multiple comorbidities such as renal dysfunction (p < 0.001), arterial hypertension (p < 0.001), anemia (p < 0.001) and peripheral vascular disease (p < 0.001). All-cause in-hospital mortality of diabetics was higher compared to non-diabetics (11.7%vs 9.8%, p = 0.01). The multivariate analysis revealed that older age (p = 0.032), systolic blood pressure < 100 mm Hg (p < 0.001), acute coronary syndrome and non compliance as precipitating factors (p = 0.05 and p = 0.005, respectively), history of arterial hypertension (p = 0.022), LVEF < 50%(p < 0.001), serum creatinine > 1.5 mg/dl (p = 0.029), absence of life saving therapies such as ACE inhibitors/ARBs (p < 0.001) and beta-blockers (p = 0.014) at admission, as well as absence of interventional treatment by PCI (p < 0.001), were independently associated with adverse in-hospital outcome.
Diabetics with AHF have higher in-hospital mortality than non-diabetics despite their intensive treatment regimens (regarding care for HF and ACS), possibly due to underlying ischemic heart disease and the presence of multiple comorbidities.