Patients With Diabetes and Heart Failure May Face Worse Outcomes, Increased HFpEF Risk

New research highlighted significant disparities between patients with heart failure (HF) with and without diabetes, as patients with diabetes were more likely to develop HF with preserved ejection fraction (HFpEF) and have more adverse renal and lipid profiles.

Published in the International Journal of General Medicine, this prospective study utilized data from the Jordanian Heart Failure Registry (JoHFR) to categorize patients with HF by diabetes status and HF type—HFpEF or HF with reduced EF (HFrEF)—collecting information on demographics, clinical presentations, and treatment outcomes.¹ The researchers used statistical analyses and machine learning techniques to predict mortality among these patients, including recursive feature elimination with cross-validation and synthetic minority over-sampling technique with edited nearest neighbors.

The study had 2007 total patients, including 1388 with diabetes and 619 without, and the researchers noted apparent differences between the 2 groups. In the JoHFR, patients with diabetes tended to be male, older, and have obesity (P < .001).

Compared with patients without diabetes, those with diabetes had a higher incidence of HFpEF (94.3% vs 39.5%), as well as significantly higher levels of cholesterol and low-density lipoprotein, reduced hemoglobin levels, and more severe renal impairment based on estimated glomerular filtration rate. Interestingly, HFrEF was much less common among both groups, occurring in 5.7% of patients with diabetes and 6.5% of those without.

When categorized by diabetes status and EF type, the researchers found significant differences in sex distribution, age, and hypertension prevalence among the groups. Most patients had diabetes and HFrEF, and most of these patients were men or aged 60 and older. Across all 4 subgroups—patients with HFpEF or HFrEF with or without diabetes—most patients had hypertension, an above normal body mass index, dyslipidemia, and no chronic kidney disease or family history of premature death.

The researchers also observed notable differences in atrial fibrillation prevalence and mortality rates between patients with HFrEF with and without diabetes, with the most cases of each in patients with diabetes and HFrEF. No significant differences were observed in the history of implanted devices or structural heart disease across the 4 subgroups.

“These trends are critical for clinicians to consider, as they suggest that targeted screening and intervention strategies could significantly benefit these high-risk groups,” the researchers wrote.

Machine learning models predicted mortality with 90.02% accuracy and an area under the ROC curve of 80.51%, with mortality predictors including creatinine levels >115 μmol/L, length of hospital stay, and need for mechanical ventilation.

It’s important to note this analysis is based on data from Jordan, potentially limiting its generalizability to other populations such as the US. The use of registry data also introduces biases such as missing information and reporting inaccuracies, and inconsistencies in recording key factors may affect the strength of these conclusions. Additionally, the relatively short follow-up duration up to 12 months may not fully capture long-term outcomes, and the lack of detailed HbA1c data limits the assessment of diabetes severity on HF outcomes. Lastly, the mortality models used have not been externally validated, necessitating further studies to confirm their applicability in diverse populations and health care settings.

A 2021 study in ESC Heart Failure had found that being male and having cancer, diabetes, or higher tricuspid regurgitation peak velocity were key predictors of long-term mortality and hospitalization for patients with HFpEF.² In that study, patients with diabetes were identified as having a significantly higher risk of adverse outcomes, highlighting the importance of monitoring and managing diabetes in HFpEF cases. Further research looking into how diabetes affects HF type and outcomes is warranted.

References

1. Izraiq M, Almousa E, Hammoudeh S, et al. Impact of diabetes mellitus on heart failure patients: insights from a comprehensive analysis and machine learning model using the Jordanian heart failure registry. Int J Gen Med. 2024;17:2253-2264. doi:10.2147/IJGM.S465169
2. Klein HE. Gender, cancer, diabetes among predictors of mortality for patients with HFpEF. AJMC. August 18, 2021. Accessed May 29, 2024. https://www.ajmc.com/view/gender-cancer-diabetes-among-predictors-of-mortality-for-patients-with-hfpef