The WATCH-DM Risk Score Estimates Clinical Outcomes in Type 2 Diabetic Patients with Heart Failure with Preserved Ejection Fraction

Abstract Background: The coexistence of heart failure is frequent and associated with higher mortality in patients with type 2 diabetes (T2DM), and its management is a critical issue. The WATCH-DM risk score is a tool to predict heart failure in patients with type 2 diabetes mellitus (T2DM). We investigated whether it could estimate outcomes in T2DM patients with heart failure with preserved ejection fraction (HFpEF). Methods:The WATCH-DM risk score was calculated in 418 patients with T2DM hospitalized for HFpEF (male 49.5%, age 80±9 years, HbA1c 6.8±1.0%), and they were divided into the “average or lower” (≤10 points), “high” (11-13 points) and “very high” (≥14 points) risk groups. We followed patients to observe all-cause death for 386 days (median). We compared the area under the curve (AUC) of the WATCH-DM score for predicting 1-year mortality with that of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score and of the Barcelona Bio-Heart Failure Risk (BCN Bio-HF). Results: Among the study patients, 108 patients (25.8%) had average or lower risk scores, 147 patients (35.2%) had high risk scores, and 163 patients (39.0%) had very high risk scores. The Cox proportional hazard model selected the WATCH-DM score as an independent predictor of all-cause death (HR per unit 1.10, 95% CI 1.03 to 1.19), and the “average or lower” risk group had lower mortality than the other groups (p=0.047 by log-rank test). The AUC of the WATCH-DM for 1-year mortality was 0.64 (95% CI; 0.45 to 0.74), which was not different from that of the MAGGIC score (0.72, 95% CI 0.63 to 0.80, p=0.08) or that of BCN Bio-HF (0.70, 0.61 to 0.80, p=0.25). Conclusion: The WATCH-DM risk score can estimate prognosis in T2DM patients with HFpEF and can identify patients at higher risk of mortality. It can be a useful tool for heart failure management in T2DM patients.