Prevalence and evolution of heart failure in patients with type 2 diabetes mellitus at high cardiovascular risk (HF-LANDMARK study).
TL;DR
The low prevalence of symptomatic HF and low rate of HF-progression likely reflect effective monitoring and intervention at preclinical HF stages, and the substantial healthcare-burden highlights an unmet need regarding implementation of HF preventive management strategies in patients with T2D.
Abstract
Aims
To estimate the prevalence of undiagnosed, symptomatic heart failure (HF) and progression of HF in a contemporary cohort of patients with type 2 diabetes (T2D).
Methods
This was an epidemiologic, 2-year prospective cohort study that enrolled outpatients with T2D, diagnosed within the prior 10 years, with high/very high cardiovascular risk but no HF history. Prevalence and incidence of symptomatic HF (ACC/AHA stages C/D) and cardiovascular-related healthcare resource utilization (HCRU) rates were estimated.
Results
From 20-Jul-2020 to 31-Oct-2022, 241 consecutive patients [61.8% males, median (IQR) age 63.0 (57.0-69.0) years] were enrolled; 0.8% (95% CI: 0.00-1.98) had symptomatic (stage C) HF; 91.3% (95% CI: 87.73-94.85) stage A and 7.9% (95% CI: 4.48-11.29) stage B HF. During follow-up, 2.8% (6/215) of evaluable patients experienced HF progression [time-to-progression, median (range): 19.8 (5.9-24.1) months]. Incidence rate of symptomatic HF among patients with preclinical (stage A/B) HF at enrollment was 0.44/100 patient-years (95% CI: 0.11-1.77). Cardiovascular-related HCRU were reported by 54.7% (87/159) of patients, corresponding to incidence rate of 51.68 encounters/100 patient-years.
Conclusions
Whereas the low prevalence of symptomatic HF and low rate of HF-progression likely reflect effective monitoring and intervention at preclinical HF stages, the substantial healthcare-burden highlights an unmet need regarding implementation of HF preventive management strategies in patients with T2D.