COMORBIDITIES AND THEIR IMPLICATIONS IN PATIENTS WITH AND WITHOUT TYPE 2
DIABETES MELLITUS AND HEART FAILURE WITH PRESERVED EJECTION FRACTION.
FINDINGS FROM THE RICA REGISTRY
Abstract
AIM: to determine if patients with heart failure and preserved ejection
fraction (HFpEF) and type 2 diabetes mellitus (T2DM) have a higher
comorbidity burden than those without T2DM, if other comorbidities are
preferentially associated with T2DM, and if these conditions confer a
worse patient prognosis. METHODS AND RESULTS: Cohort study based on the
RICA Spanish Heart Failure Registry, a multicenter, prospective registry
that enrolls patients admitted for decompensated HF and follows them for
1 year. We selected only patients with HFpEF, classified as having or
not having T2DM, and performed an agglomerative hierarchical clustering
based on variables such as the presence of arrhythmia, chronic
obstructive pulmonary disease, dyslipidemia, liver disease, stroke,
dementia, body mass index (BMI), hemoglobin levels, estimated glomerular
filtration rate, and systolic blood pressure. 1,934 patients were
analyzed: 907 had T2DM (mean age 78.4+/-7.6 years) and 1,027 did not
(mean age 81.4+/- 7.6 years). The analysis resulted in 4 clusters in
patients with T2DM, and 3 in the reminder. All clusters of patients with
T2DM showed higher BMI, and more kidney disease and anemia than those
without T2DM. Clusters of patients without T2DM had neither
significantly better nor worse outcomes. However, among the T2DM
patients, clusters 2, 3 and 4 all had significantly poorer outcomes, the
worst being cluster 3 (HR 2.0, 95% CI 1.36-2.93, p=0.001). CONCLUSIONS:
Grouping our patients with HFpEF and T2DM into clusters based on
comorbidities revealed a greater disease burden and prognostic
implications associated with the T2DM phenotype, compared to those
without T2DM.