3380Development of heart failure in type 2 diabetes: ischemic heart disease, end stage renal disease or hypertension and diabetes? A nationwide cohort study

Abstract

Background: Heart failure (HF) is an overlooked challenge in the care of type 2 diabetes (T2D). However, due to randomized trials evaluating sodium glucose cotransporter (SGLT2) inhibitors, HF in T2D is now gaining interest. Little is known about how T2D patients develop HF and the proportion of patients developing ischemic heart disease (IHD) and end stage renal disease (ESRD) prior to developing HF is unknown. Purpose: To investigate the proportion of T2D patients that developed IHD, ESRD or neither before they developed HF and afterwards to evaluate the association between the three different roads to HF and the associated risk of death. Methods: All Danish individuals between 1995 and 2015 redeeming first-time prescription of a non-insulin blood glucose-lowering drug were identified and defined as T2D patients. T2D patients who developed HF were included and divided into three groups: T2D without IHD and ESRD, T2D with IHD and T2D with ESRD. Patients with HF prior to T2D were excluded. HF, IHD and ESRD diagnosis were defined as the first hospitalization with a relevant International Classification of Diseases (ICD) code or a procedure code for coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) and dialysis. Cox proportional hazard models, adjusted for age, sex, comorbidities, use of insulin during follow up and duration of diabetes, were used to model risk of all cause death in the 3 groups, with T2D without IHD or ESRD as reference. All data was collected from Danish nationwide registries. Results: We identified 368.955 patients with T2D, of whom 24.549 (7%) had incident HF subsequently. The median age was 76 years (Q1-Q3: 68-83) and 58% were men. A total of 11.915 (49%) patients had HF without IHD or ESRD, 12.359 (50%) had T2D and IHD, whereas only 275 (1%) had T2D and ESRD. The median age when diagnosed with HF was 77 years (Q1-Q3: 69-84), 75 years (Q1-Q3: 67-82) and 68 years (Q1-Q3: 63-75), respectively. We observed that HF after T2D and IHD was associated with a significantly lower risk of death with a hazard ratio (HR) of 0.89 (95% CI: 0.86-0.92), p<0.001 and HF after ESRD was associated with a significantly increased risk of death, HR: 1. 62 (1.35-1.95) p<0.001, compared to HF after T2D without IHD or ESRD. (Figure presented) Conclusion: In this real life T2D population, 7% developed HF during our study period. Of those, 49% developed HF independently of IHD and ESRD, and we observed that these patients had a slightly worse prognosis compared to patients with both T2D and IHD. To understand this association better, more focus on development of HF due to T2D per se is warranted.