Prevalence, clinical and prognostic role of type 2 diabetes in patients with heart failure: a subanalysis of the PRIORITY-HF study

Aim. To assess the prevalence, clinical features and prognostic value of type 2 diabetes (T2D) in outpatients with heart failure (HF).

Material and methods. According to the PRIORITY-HF study, a retrospective analysis of T2D prevalence, features of control and treatment of related comorbid conditions was performed in a cohort of 19939 patients with HF. The prognostic role of T2D and glycated

hemoglobin (HbA1c) was estimated using the multivariate Cox regression model. Results. The prevalence of T2D in patients with HF was 27,4%. The HbA1c level at visit 1 was determined in 37,6% of patients with T2D and in 11,6% of cases without T2D. Patients with T2D compared to those without T2D were characterized by a higher burden of cardiovascular comorbidities and such non-cardiac concomitant conditions as chronic kidney disease, anemia, bronchial asthma. Patients with T2D had a higher functional class, longer duration of HF, and a greater HF-related hospitalization rate. At baseline, T2D was associated with more frequent prescription of angiotensin II receptor blockers, renin-angiotensin-aldosterone system blockers, mineralocorticoid receptor antagonists, beta-blockers, sodium-glucose cotransporter-2 (SGLT2) inhibitors. After visit 1, both subgroups showed a prescription rate increase in all classes of guideline-directed medical therapy (GDMT), especially SGLT2 inhibitors. The proportions of patients receiving target GDMT doses were low in both subgroups with and without T2D, but titration of doses of all GDMT classes was more effective among patients with T2D. Metformin was most often used for glycemic control, followed by SGLT2 inhibitors and sulfonylureas, which are not front-line therapy for HF. Patients with T2D were characterized by a more unfavorable prognosis compared to the cohort without T2D. In the subgroup of patients with T2D, HbA1c >9% was associated with an increased all-cause mortality, as well as all-cause and HF-related hospitalization rates.

Conclusion. T2D in patients with HF is associated with a more severe HF course, worsens the prognosis and requires increased awareness of physicians on the diagnostic and therapeutic tactics for managing this cohort of patients.

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