HFpEF as the Predominant and Underrecognized Heart Failure Phenotype in Type 2 Diabetes
Background
Heart failure (HF) is a serious complication of type 2 diabetes (T2D). Among HF types, heart failure with preserved ejection fraction (HFpEF) has become the most common, yet its clinical features, prognosis, and treatment compared to heart failure with reduced ejection fraction (HFrEF) are not well defined.
Objectives
This study aimed to compare the characteristics, outcomes, and long-term management of HFpEF versus HFrEF in patients with T2D.
Methods
A prespecified subanalysis of the nationwide, prospective DIABET-IC study was conducted, including 1517 patients with T2D from 58 Spanish centers. Patients were followed for three years, and HF phenotypes were classified according to the 2016 ESC guidelines. Baseline features, mortality, hospitalizations, disease progression, and treatment patterns were evaluated.
Results
- At baseline, 490 patients had heart failure: 50.2% with HFrEF, 30.6% with HFpEF, and 19.2% with mid-range EF (HFmrEF).
- Patients with HFpEF were generally older, more often female, and had higher rates of obesity, hypertension, and metabolic syndrome.
- In contrast, HFrEF patients were more frequently associated with ischemic heart disease, prior ST-elevation myocardial infarction (STEMI), and conduction abnormalities.
- During follow-up, HFpEF was the main new heart failure phenotype, accounting for 46.6% of incident cases, with 4.7% of HFpEF patients progressing to HFrEF.
- Mortality rates were similarly high in both HFpEF and HFrEF groups.
- Hospitalizations for heart failure tended to be more frequent in HFrEF, while acute coronary syndromes occurred more commonly in HFpEF.
"HFpEF patients were older, more often female, and had higher prevalence of obesity, hypertension, and metabolic syndrome, whereas HFrEF was more strongly associated with ischemic heart disease, prior STEMI, and conduction disturbances."
"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
This study highlights HFpEF as the most common and often unrecognized heart failure phenotype in type 2 diabetes, showing distinct clinical profiles and comparable mortality to HFrEF but differing in hospitalization and event patterns.