HFpEF as the Predominant Heart Failure Phenotype in Type 2 Diabetes
Background
Heart failure (HF) is a serious complication of type 2 diabetes (T2D), with heart failure with preserved ejection fraction (HFpEF) now identified as the most common phenotype. Despite its prevalence, the clinical features, prognosis, and treatment strategies of HFpEF compared to heart failure with reduced ejection fraction (HFrEF) remain inadequately described.
Objectives
This study aimed to compare the characteristics, outcomes, and management over time of HFpEF versus HFrEF among patients with T2D.
Methods
A prespecified subanalysis of the nationwide, prospective DIABET-IC cohort was conducted, including 1,517 patients with T2D from 58 Spanish centers, followed for three years. HF phenotypes were classified according to the 2016 ESC guidelines. Researchers assessed baseline characteristics, mortality, hospitalizations, disease progression, and treatment patterns.
Results
- At baseline, 490 patients had heart failure:
- 50.2% with HFrEF
- 30.6% with HFpEF
- 19.2% with HFmrEF (mid-range EF)
- Patients with HFpEF were older, more frequently female, and had higher rates of obesity, hypertension, and metabolic syndrome.
- HFrEF was strongly linked with ischemic heart disease, prior ST-elevation myocardial infarction (STEMI), and conduction abnormalities.
- During follow-up:
- HFpEF became the most common new HF phenotype, accounting for 46.6% of incident cases.
- 4.7% of HFpEF cases progressed to HFrEF.
- Both phenotypes showed similarly high mortality rates.
- HF hospitalizations tended to be higher in HFrEF.
- Acute coronary syndromes were more frequent in HFpEF.
"During follow-up, HFpEF was the predominant incident phenotype (46.6% of new cases), and 4.7% progressed to HFrEF. Mortality was similarly elevated in both phenotypes; HF hospitalizations tended to be higher in HFrEF, while acute coronary syndromes were more frequent in HFpEF."
Author's Summary
HFpEF is the most common and often underrecognized heart failure phenotype in T2D, with distinct clinical features and comparable mortality to HFrEF, highlighting the need for tailored management strategies.