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Prevalence prognostic impact of diabetes in heart failure with preserved, mid-range and reduced ejection fraction
1Kyungpook National University Hospital - Daegu - Korea (Republic of)
On behalf: KorAHF registry investigators
Diabetes is common comorbid condition in patients with heart failure and worsens the prognosis of the patients. Prevalence and prognostic impact of diabetes on the heart failure patients with preserved (HFpEF), mid-range (HFmrEF) and reduced ejection fraction (HFrEF) is not well known. This study was aimed to investigate the prevalence and clinical impact of diabetes depending on heart failure subtypes of HFpEF, HFmrEF, and HFrEF.
From Korean acute heart failure registry, 5,116 in-hospital survivors were included in the present study. Prevalence and clinical impact of diabetes were evaluated according to the subgroups divided by ejection fraction (EF) <40%, 40-49%, and =50%. Composite event of all-cause mortality and hospitalization for heart failure was analyzed as prognosis using Cox proportional hazard model.
Among the study population, 25.7% had HFpEF, 16.5% had HFmrEF, and 57.8% had HFpEF. During 1-year follow-up, 50.1% of composite event were observed. Adverse event rates of each subgroup were 17.6%, 15.9%, and 19.1%, which was not significantly different among the three groups (p=0.089). Prevalence of diabetes in HFpEF, HFmrEF, and HFrEF were 33.8%, 38.8%, and 41.5%, respectively (p<0.001). Diabetes was more frequently observed in patients with lower EF. Diabetes was not significantly associated with worse outcome In HFpEF (hazard ratio [HR] 1.215 [0.996-1.482], p=0.055), whereas diabetes was significantly related to worse outcome in HFmrEF (HR 1.332 [1.032-1.718], p=0.027) and HFrEF (HR 1.368 [1.212-1.543], p<0.001). After multivariable adjustment, diabetes remained as an independent risk factor in patients with HFrEF (HR 1.199 [1.054-1.364], p=0.006). However, the relation was weak in HFpEF (HR 1.11 [0.898-1.372], p=0.335) and HFmrEF (HR 1.128 [0.852-1.492], p=0.401).
In patients with heart failure, diabetes was more frequently observed as EF decreased. Diabetes was associated with worse clinical outcome especially in patients with HFrEF increasing adverse event risk by 20%, whereas the association was weaker in HFpEF and HFmrEF.
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