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Metformin and risk of long-term mortality following an admission for acute heart failure

Fácila, Lorenzo; Fabregat-Andrés, Óscar; Bertomeu, Vicente; Navarro, Juan P.; Miñana, Gema; García-Blas, Sergio; Valero, Ernesto; Morell, Salvador; Sanchis, Juan; Núñez, Julio

Journal of Cardiovascular Medicine: February 2017 - Volume 18 - Issue 2 - p 69–73
doi: 10.2459/JCM.0000000000000420
Original article: Heart failure

Aims Optimal diabetic treatment in patients with established heart failure remains unclear. Metformin has been traditionally considered well tolerated in patients with cardiovascular disease, although there is scarce information regarding the prognostic implications of metformin in acute heart failure. We sought to evaluate the association between metformin therapy and risk of long-term mortality in patients discharged for decompensated heart failure.

Methods We included 835 consecutive type 2 diabetic patients discharged from a cardiology department of a third-level center. All-cause mortality was considered as the primary endpoint and the effect of metformin therapy across the most representative subgroups in heart failure as a secondary endpoint. The association between metformin with all-cause mortality was evaluated by using a Cox regression method. Multivariate analysis included solid prognostic covariates in heart failure.

Results At a mean follow-up of 2.4 ± 2 years, mortality rates were significantly lower in patients on treatment with metformin: 1.34 (1.04–1.65) × 10 vs. 2.24 (2.0–2.51) × 10 person-years (P < 0.001). Kaplan–Meier curve revealed a progressive separation of curves already observed during first months of follow-up (log-rank test P < 0.001). In multivariate analysis, this prognostic association remained significant.

Conclusion In this cohort of patients with acute heart failure and diabetes, metformin appears to be well tolerated and may be associated with favorable clinical outcomes.

aCardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia

bCardiology Department, Hospital Universitario de San Juan, Alicante

cCardiology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain

Correspondence to Óscar Fabregat-Andrés, Cardiology Department, Consorcio Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014 Valencia, Spain Tel: +34 963131800; e-mail:

Received 25 January, 2016

Revised 28 May, 2016

Accepted 31 May, 2016

© 2017 Italian Federation of Cardiology. All rights reserved.