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September 5, 2007

Lower Rates of Heart Failure and Death in Acute Coronary Syndromes—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(9):969-971. doi:10.1001/jama.298.9.970-b

In Reply: Dr Cubbon and colleagues describe their findings in diabetic patients and comment that we did not separately report outcomes in patients with diabetes. Reporting outcomes in subsets was beyond the scope of this article. Nevertheless, we have analyzed the outcomes in patients with prior documented diabetes (27% of those with non–ST-segment ACS; 21% of those with STEMI). Congestive heart failure declined in diabetic patients with non-STEMI from 15.9% in July-December 1999 to 9.8% in July-December 2005 (P < .001). For all non-STEMI patients, the decline was from 12.3% to 7.7% (P < .001). We observed no significant change in raw or risk-adjusted death rates in diabetic patients (whereas mortality was significantly reduced for the whole population [P = .02]). Similarly, in diabetic patients with STEMI, congestive heart failure declined from 29.5% to 12.8% (P < .001), and correspondingly for all patients from 19.6% to 10.7% (P < .001). Thus, our findings suggest a consistent effect on decline in new heart failure in diabetic patients. We have not demonstrated a change in mortality, but this may be the consequence of the smaller sample size.