(P159) EVALUATING THE BURDEN OF DIABETES ON HEART FAILURE RELATED MEDICAL OPTIMIZATION AND HEALTH STATUS IN A SPECIALIZED CLINIC-BASED COHORT

Background: Diabetes mellitus (DM) is a well-established risk factor for adverse prognosis in patients with heart failure (HF). We evaluated outcomes, quality of life (QoL) and guideline-directed medical therapy (GDMT) utilization in patients with DM and HF.

METHODS AND RESULTS: Consecutive patients with HF attending appointments at the Mazankowski Alberta Heart Institute Heart Failure Clinic (HFC) were enrolled into a patient registry. 1,301 Patients were prospectively enrolled between February 2018 and August 2022. We examined all-cause mortality or deaths/cardiovascular hospitalizations in addition to QoL and GDMT utilization during this timeframe.
Patients with DM had higher rates of co-morbidities with the largest differences seen in hypertension (70.6% vs 43.8%), dyslipidemia (32.8% vs 16.9%) and chronic kidney disease (44.7% vs 26.1%), compared to those without DM (all p values < 0.001). Additionally, it was more common for patients with DM to have HF secondary to ischemic heart disease (p < 0.001). Patients without DM were more likely to have HFpEF compared to those with DM (p < 0.05, Figure 1A). The main significant difference in GDMT utilization was SGLT2i usage across all HF sub-types, which was much higher in the DM group (33.8% vs. 3.1%, p < 0.001, Figure 1B). In the heart failure with reduced ejection fraction (HFrEF) group for the overall cohort, GDMT utilization was 17.9% for SGLT2i, 96.5% for beta-blocker, 82.0% for MRA, and 94.6% for ACEi/ARB/ARNI (Figure 1B). Additionally, In the HFrEF group for the overall cohort, 81.0% were on triple therapy and 16.0% on quadruple therapy. Patient-reported QoL was worse in those with DM (median 68.1, IQR: 45.8 – 87.5) compared to those without DM (76.0, IQR: 53.1 – 92.7, p < 0.001, Figure 1C). When comparing patients based on ejection fraction only, QoL was significantly better in the heart failure with preserved ejection fraction (HFpEF) group compared to HFrEF and heart failure mildly reduced ejection fraction (HFmrEF) patients (p < 0.001, Figure 1D).
During a median follow-up time of 38.7 months (IQR: 30.7 – 48.2 months), patients with DM exhibited an increased risk of composite outcomes (aHR: 1.34, 95% CI 1.13 – 1.60, Figure 1E,G) and all-cause mortality alone (aHR: 1.12, 95% CI 1.01 – 1.43, Figure 1F,G) compared to non-DM patients.

Conclusion: This study showcases that even with high rates of GDMT utilization in a contemporary specialized clinic, patients with concomitant HF and DM continues to experience poorer QOL and worse outcomes than HF patients without DM.