Physicians' Academy for Cardiovascular Education

Diabetic HFpEF patients have worse outcomes than non-diabetics

Clinical and Echocardiographic Characteristics and Cardiovascular Outcomes According to Diabetes Status in Patients with Heart Failure and Preserved Ejection Fraction. A Report from the Irbesartan in Heart Failure with Preserved Ejection Fraction Trial (I-Preserve)

Kristensen SL, Mogensen UM, Jhund PS et al. - Circulation. 2017;CIRCULATIONAHA.116.024593

Background

Diabetes (DM) may play an important role in the development of Heart Failure with Preserved Ejection Fraction (HFpEF) and is associated with worse outcomes in HFpEF patients [1,2]. Moreover, while some anti-diabetes drugs may increase the risk of heart failure (HF), others may decrease it [3-5]. The pathophysiological mechanisms underlying these findings are unclear.

In this analysis, the risk of adverse CV outcomes according to DM status was investigated in 4128 patients with HFpEF included in the I-Preserve study (Irbesartan in Heart Failure with Preserved Ejection Fraction trial). In this trial, patients received the angiotensin II receptor antagonist irbesartan and 27% of these patients had DM.

Main results

Echocardiographic measurements (745 patients) showed that compared with patients without DM, DM patients had:

DM patients had higher NT-proBNP levels and a significantly worse quality of life as measured by the Minnesota Living with Heart Failure score.

Conclusion

HFpEF patients with DM have more signs of congestion, worse quality of life, higher NT-proBNP levels, greater structural and functional echocardiographic abnormalities and worse clinical outcomes compared with those without diabetes. These findings support the hypothesis that more intensive diuretic medication may be necessary for these patients.

References

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Find this article online at Circulation