Prevalence and evolution of heart failure in patients with type 2 diabetes mellitus at high cardiovascular risk (HF-LANDMARK study).

Aims

To estimate the prevalence of undiagnosed, symptomatic heart failure (HF) and progression of HF in a contemporary cohort of patients with type 2 diabetes (T2D).

Methods

This was an epidemiologic, 2-year prospective cohort study that enrolled outpatients with T2D, diagnosed within the prior 10 years, with high/very high cardiovascular risk but no HF history. Prevalence and incidence of symptomatic HF (ACC/AHA stages C/D) and cardiovascular-related healthcare resource utilization (HCRU) rates were estimated.

Results

From 20-Jul-2020 to 31-Oct-2022, 241 consecutive patients [61.8% males, median (IQR) age 63.0 (57.0-69.0) years] were enrolled; 0.8% (95% CI: 0.00-1.98) had symptomatic (stage C) HF; 91.3% (95% CI: 87.73-94.85) stage A and 7.9% (95% CI: 4.48-11.29) stage B HF. During follow-up, 2.8% (6/215) of evaluable patients experienced HF progression [time-to-progression, median (range): 19.8 (5.9-24.1) months]. Incidence rate of symptomatic HF among patients with preclinical (stage A/B) HF at enrollment was 0.44/100 patient-years (95% CI: 0.11-1.77). Cardiovascular-related HCRU were reported by 54.7% (87/159) of patients, corresponding to incidence rate of 51.68 encounters/100 patient-years.

Conclusions

Whereas the low prevalence of symptomatic HF and low rate of HF-progression likely reflect effective monitoring and intervention at preclinical HF stages, the substantial healthcare-burden highlights an unmet need regarding implementation of HF preventive management strategies in patients with T2D.