HFpEF as the Predominant and Underrecognized Heart Failure Phenotype in Type 2 Diabetes
Background
Heart failure (HF) is a major complication of type 2 diabetes (T2D). Among HF types, heart failure with preserved ejection fraction (HFpEF) has become the most common phenotype. However, the clinical characteristics, prognosis, and treatment differences between HFpEF and heart failure with reduced ejection fraction (HFrEF) in T2D are not fully understood.
Objectives
To compare the clinical features, outcomes, and longitudinal treatment approaches of HFpEF versus HFrEF in patients with type 2 diabetes.
Methods
This analysis is based on the DIABET-IC cohort, a nationwide prospective study conducted in Spain. It included 1,517 T2D patients from 58 centers, followed for three years. HF phenotypes were categorized according to the 2016 ESC guidelines. The study assessed baseline traits, mortality, hospitalizations, disease progression, and therapy regimens.
Results
- At baseline, 490 patients had heart failure:
- 50.2% had HFrEF
- 30.6% had HFpEF
- 19.2% had HF with mid-range ejection fraction (HFmrEF)
- HFpEF patients tended to be older, predominantly female, and had higher rates of obesity, hypertension, and metabolic syndrome.
- HFrEF was more commonly linked to ischemic heart disease, previous ST-elevation myocardial infarction (STEMI), and conduction abnormalities.
- During follow-up:
- HFpEF emerged as the most frequent new HF phenotype (46.6% of new cases).
- 4.7% of HFpEF patients progressed to HFrEF.
- Mortality rates were similarly high in both phenotypes.
- Hospitalizations for HF were somewhat higher in HFrEF patients.
- Acute coronary syndromes occurred more often in HFpEF patients.
"HFpEF patients were older, more often female, and had higher prevalence of obesity, hypertension, and metabolic syndrome."
"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 a common and often overlooked heart failure type in T2D, with distinct patient traits and similarly poor outcomes compared to HFrEF, highlighting the need for tailored management strategies.