Wong Curtis, Junqueira Erica, Poldiak Nayda P, Crossley Nancy, Jenkins Shantae
Trident Health, Internal Medicine Residency Program, United States.
HCA Healthcare, Graduate Medical Education, United States.
J Community Hosp Intern Med Perspect. 2024 Jul 2;14(4):12-17. doi: 10.55729/2000-9666.1366. eCollection 2024.
The consequences of discontinuing metformin in patients with heart failure have not been determined. Knowing that acute exacerbation of chronic heart failure contributes to substantial increases in major adverse cardiovascular events (MACE), we proposed a retrospective study to examine whether discontinuing metformin in patients hospitalized with heart failure impacts mortality and readmission rates.
We conducted a retrospective analysis of patients admitted with a diagnosis of acute heart failure to hospitals in the HCA Healthcare System from 2020 to 2022. Included patients had a prior diagnosis of diabetes mellitus, acute heart failure, and were taking metformin prior to admission. After applying our exclusion criteria, a total of 7740 patients remained. The primary outcomes were 30-, 60-, and 90-day readmission rates and secondary outcomes were mortality and length of stay.
Patients who were discharged without a prescription for metformin (NONDIS-MET) were 4.489 (95% CI 3.673-5.488, p < 0.0001) times more likely to have a MACE outcome in 30 days compared to patients who received a discharge order for metformin (DIS-MET). The findings were similar for 60-day and 90-day readmission rates, with NONDIS-MET patients 3.457 (95% CI 2.893-4.131, p < 0.0001) and 2.992 (95% CI 2.534-3.533 p < 0.0001) times more likely to have a MACE outcome than MET patients, respectively. However, when metformin was continued during the patients' hospital stay (CONT-MET) there was no significant association with MACE outcomes, readmission, or mortality rates.
We found that diabetic patients admitted with acute heart failure exacerbations had a higher incidence of major adverse cardiac events and were more likely to be readmitted when they were not prescribed metformin after discharge. Our findings agree with prior work showing the cardioprotective effects of metformin; however, continuing metformin during hospital admission did not affect our patients adverse outcomes.
心力衰竭患者停用二甲双胍的后果尚未确定。鉴于慢性心力衰竭急性加重会导致主要不良心血管事件（MACE）大幅增加，我们开展了一项回顾性研究，以探讨心力衰竭住院患者停用二甲双胍是否会影响死亡率和再入院率。
我们对2020年至2022年在HCA医疗保健系统各医院因急性心力衰竭入院的患者进行了回顾性分析。纳入患者此前已诊断患有糖尿病和急性心力衰竭，且入院前正在服用二甲双胍。应用排除标准后，共留下7740例患者。主要结局为30天、60天和90天再入院率，次要结局为死亡率和住院时间。
与出院时收到二甲双胍医嘱的患者（DIS-MET）相比，出院时未开具二甲双胍处方的患者（NONDIS-MET）在30天内发生MACE结局的可能性高4.489倍（95%CI 3.673-5.488，p<0.0001）。60天和90天再入院率的结果相似，NONDIS-MET患者发生MACE结局的可能性分别比MET患者高3.457倍（95%CI 2.893-4.131，p<0.0001）和2.992倍（95%CI 2.534-3.533，p<0.0001）。然而，当患者住院期间继续服用二甲双胍（CONT-MET）时，与MACE结局、再入院率或死亡率无显著关联。
我们发现，因急性心力衰竭加重入院的糖尿病患者发生主要不良心脏事件的发生率较高，出院时未开具二甲双胍处方时更有可能再次入院。我们的研究结果与之前显示二甲双胍具有心脏保护作用的研究一致；然而，住院期间继续服用二甲双胍并未影响我们患者的不良结局。
