Type 2 Diabetes and Heart Failure: A Comparative Analysis of Disease Trajectory and Clinical Outcomes
Background: Approximately 40 million individuals in the US have diabetes, and 6.5 million are also afflicted with congestive heart failure (CHF). This paper outlines the natural history of CHF in T2DM and compares CHF outcomes between patients with and without T2DM. Methods: We performed a retrospective analysis of prospectively collected data from 2,008 patients hospitalized for CHF exacerbation between December 2016 and June 2019. Propensity score matching was used to match diabetics and nondiabetics. Outcomes included survival and readmission rates at 28 d, 3 mo and 6 mo, as well as comparison of echocardiographic findings. Results: A total of 2,008 patients were included. After matching, 492 patients were included, with 244 diabetics and 248 nondiabetics. After matching, readmission rates within 28 days (p=0.625) were not different, but there was a trend for higher readmission rates among diabetics at 3 months (29.3% vs. 21.5%, p=0.049) and 6 months (44.3% vs 35.8%, p=0.053). Echocardiographic characteristics, including LVEF (p=0.135), LV EDV (p=0.707), maximum velocity of mitral valve E wave (p=0.407), maximum velocity of mitral valve A wave (p=0.050), E/A ratio (p=0.501) and tricuspid valve regurgitation pressure (p=0.668) were not different in the two groups. However, tricuspid valve regurgitation velocity was higher in diabetics (3.1 vs 2.9, p=0.003). Conclusions: Although diabetes poses an additional burden for patients with CHF, survival is similar in diabetics and nondiabetics. Nonetheless, readmission rates may be higher among diabetics. Tricuspid return velocity is higher in diabetics, suggesting early pulmonary vasculature remodeling.