May 17, 2012Open Access

High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Type 2 diabetes (n=605). Intervention: Diagnostic assessment (echocardiography, ECG, physical examination). Primary outcome: Prevalence of previously unknown heart failure (95% CI 24.1, 31.4).

Key Result

Among patients aged 60 years or older with type 2 diabetes, the prevalence of previously unknown heart failure was 27.7%, predominantly consisting of heart failure with preserved ejection fraction.

Study Design

Type

Cross-Sectional (n=605)

Multicenter

Yes

Structured PICO

Population

605 patients aged 60 years or over with type 2 diabetes in the south west of the Netherlands, including 581 without known heart failure.

Outcome

Prevalence of previously unknown heart failure and left ventricular dysfunction

Over a quarter of older patients with type 2 diabetes without known heart failure have previously undiagnosed heart failure, predominantly with preserved ejection fraction.

Limitations

Blood pressure values were based on a single measurement.
NT-proBNP levels were not available to the expert panel during diagnosis.
Lack of specific and detailed further investigations may have led to under-rating ischaemia as a cause of heart failure.
Non-responders were older and likely more fragile, which may have led to a limited underestimation of the prevalence.

Abstract

AIMS/HYPOTHESIS: The aim of this study was to assess the prevalence of (unknown) heart failure and left ventricular dysfunction in older patients with type 2 diabetes. METHODS: In total, 605 patients aged 60 years or over with type 2 diabetes in the south west of the Netherlands participated in this cross-sectional study (response rate 48.7%), including 24 with a cardiologist-confirmed diagnosis of heart failure. Between February 2009 and March 2010, the patients without known heart failure underwent a standardised diagnostic work-up, including medical history, physical examination, ECG and echocardiography. An expert panel used the criteria of the European Society of Cardiology to diagnose heart failure. RESULTS: Of the 581 patients studied, 161 (27.7%; 95% CI 24.1%, 31.4%) were found to have previously unknown heart failure: 28 (4.8%; 95% CI 3.1%, 6.6%) with reduced ejection fraction, and 133 (22.9%; 95% CI 19.5%, 26.3%) with preserved ejection fraction. The prevalence of heart failure increased steeply with age. Heart failure with preserved ejection fraction was more common in women. Left ventricular dysfunction was diagnosed in 150 patients (25.8%; 95% CI 22.3%, 29.4%); 146 (25.1%; 95% CI 21.6%, 28.7%) had diastolic dysfunction. CONCLUSIONS/INTERPRETATION: This is the first epidemiological study that provides exact prevalence estimates of (previously unknown) heart failure and left ventricular dysfunction in a representative sample of patients with type 2 diabetes. Previously unknown heart failure and left ventricular dysfunction are highly prevalent. Physicians should pay special attention to 'unmasking' these patients.

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Cite This Study

Winter et al. (Thu,) conducted a cross-sectional in Type 2 diabetes (n=605). Diagnostic assessment (echocardiography, ECG, physical examination) was evaluated on Prevalence of previously unknown heart failure (95% CI 24.1, 31.4). Among patients aged 60 years or older with type 2 diabetes, the prevalence of previously unknown heart failure was 27.7%, predominantly consisting of heart failure with preserved ejection fraction.

synapsesocial.com/papers/6a10ef6c69716c70d0488f85 https://doi.org/https://doi.org/10.1007/s00125-012-2579-0

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