HFpEF and diabetes: What are the clinical challenges?

I'm Pardeep Jhund from the University of Glasgow, and I'm going to discuss the clinical challenges of heart failure with preserved ejection fraction and diabetes. These are my disclosures.

These are some data from Scotland from our National Diabetes Register showing the incidence of heart failure in patients with diabetes compared to patients without diabetes. You can quite clearly see that heart failure hospitalizations increase almost exponentially as patients age, but the age at which that increase happens is younger in patients with type 2 diabetes compared to patients without type 2 diabetes. We know that patients who have type 2 diabetes are at very high risk of developing heart failure over the course of their lifetime.

Indeed, other data from primary care that we have here show the same thing, but what's important to note of patients with diabetes is that actually heart failure is the first presentation of cardiovascular disease in many patients with type 2 diabetes. We often think about myocardial infarction and stroke as being the first manifestations of cardiovascular disease, but actually, heart failure is just as common. About 14% of patients, they will have heart failure as the first presentation of their cardiovascular disease.

Here are some other data from a trial that was conducted a few years ago with aliskiren, a direct renin inhibitor, the ALTITUDE trial, looking at patients with type 2 diabetes and chronic kidney disease who had either cardiovascular disease or nephropathy. As you can see here, once they were enrolled into the trial, the first event that these patients had was most often heart failure compared to end-stage renal disease, myocardial infarction, and stroke, which are complications we more often associate with type 2 diabetes, but actually, the majority of outcomes were heart failure outcomes as the first outcome these patients had. Now, if we overlie the deaths that occurred during the trial according to what their first presentation of cardiovascular disease was, you can see that the majority of deaths occurred in those patients who had heart failure as their first presentation of cardiovascular disease. It's a common outcome in patients with type 2 diabetes and unfortunately associated with a high risk of mortality.

Now, for those of us working in diabetes clinics or internal medicine, I think this is an important lesson that we must learn. There's actually a lot of unrecognized heart failure out there, and this is an analysis from a registry of patients in a diabetes clinic looking at the prevalence of unrecognized heart failure, which was diagnosed according to current criteria in that clinic setting. Again, as you can see, the prevalence rises with age, but the majority of unrecognized heart failure patients have heart failure with preserved ejection fraction. They make up the bulk of the unrecognized heart failure that's out there. Of course, that is important because we now have therapies for heart failure with preserved ejection fraction so identifying these patients allow us to find them and give them this new therapy, which reduces morbidity and mortality.

I hope I've convinced you that heart failure is a major cause of cardiovascular disease and diabetes. It is often a first presentation of cardiovascular disease, and it is unfortunately still associated with a high risk of mortality. Many of our patients go unrecognized because many of their signs and symptoms masquerade as other things which can be mistaken for the diseases that they're presenting with. With these effective treatments for heart failure with preserved ejection fraction, we need to identify these patients so they can get effective treatments earlier.

Thank you.