Sandesara PB, et al. - In a study population including patients with heart failure with preserved ejection fraction (HFpEF), prognostic utility of diabetes and microvascular complications was assessed. An association of diabetes with adverse cardiovascular outcomes was obvious and, importantly, among HFpEF patients with diabetes, the inherent risk of adverse outcomes varied by the presence of microvascular complications.

Methods

• A total of 3,385 patients (mean age 69 ± 9.6 years; 49% male; 89% white) with HFpEF were included in this analysis from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial (TOPCAT).
• Self-reported history and medical record review were used to ascertain diabetes and microvascular complications.
• Neuropathy, nephropathy, and retinopathy were included as microvascular complications.
• Hospitalization, hospitalization for heart failure, death, and cardiovascular death were the outcomes.
• Using Cox regression, the risk of each outcome associated with diabetes and microvascular complications was assessed.

Results

• At least one microvascular complication was detected in 352 (32%) subjects out of the total 1,109 subjects (32%) with diabetes.
• Findings demonstrated that patients with diabetes and microvascular complications had an increased risk for hospitalization (no diabetes: referent; diabetes + no microvascular complication: hazard ratio [HR] 1.18, 95% CI 1.01, 1.37; diabetes + microvascular complications: HR 1.54, 95% CI 1.25, 1.89; P-trend <0.001), hospitalization for heart failure (no diabetes: referent; diabetes + no microvascular complication: HR 1.51, 95% CI 1.14, 1.99; diabetes + microvascular complications: HR 1.97, 95% CI 1.38, 2.80; P-trend <0.001), death (no diabetes: referent; diabetes + no microvascular complication: HR 1.35, 95% CI 1.04, 1.75; diabetes + microvascular complications: HR 1.73, 95% CI 1.22, 2.45; P-trend = 0.0017), and cardiovascular death (no diabetes: referent; diabetes + no microvascular complication: HR 1.34, 95% CI 0.96, 1.86; diabetes + microvascular complications: HR 1.70, 95% CI 1.09, 2.65; P-trend = 0.018).
• In addition, data showed that a higher risk of rehospitalization for heart failure was observed across diabetes categories, when the analysis was limited to participants who reported prior hospitalization for heart failure (n = 2,449) (no diabetes: referent; diabetes + no microvascular complication: HR 1.40, 95% CI 1.01, 1.96; diabetes + microvascular complications: HR 1.78, 95% CI 1.18, 2.70; P-trend = 0.0036).