Heart failure with reduced, mid-range and preserved left ventricular ejection fraction in Chinese with type 2 diabetes: risk factors and prognosis from time of first index hospitalization

BackgroundThe clinical predictors and prognosis of heart failure (HF) by categories of left ventricular ejection fraction (LVEF) have not been well studied in people with diabetes. In a retrospective cohort of Chinese with type 2 diabetes, we examined 1) clinical factors associated with incident decompensated HF, and 2) mortality post-HF, stratified by LVEF.MethodsWe conducted a retrospective analysis of the Hong Kong Diabetes Register comprising 23,348 people with type 2 diabetes without history of HF enrolled between 1993–2015, followed for incident decompensated HF until 2017. Heart failure subtypes were defined according to LVEF on echocardiography. Multivariate Cox proportional hazards models were used to identify clinical factors associated with incident HF versus no HF, stratified by HF subtypes. All-cause mortality rates were compared by HF subtypes.ResultsOver median follow-up of 7.1 years from enrolment, 1,195 (5.1%) people developed decompensated HF. Among 611 (51.1%) people with echocardiography, 24.1% had HF with reduced LVEF (HFrEF) (LVEF < 40%), 15.2% had HF with mid-range LVEF (HFmrEF) (LVEF 41–49%), and 60.7% had HF with preserved LVEF (HFpEF) (LVEF ≥ 50%). Old age, low GFR, albuminuria and coronary artery disease were associated with increased hazards for all HF subtypes. During median follow-up of 2.1 years post-HF, 760 (63.6%) people died. One-year mortality rate was lower in people with HFpEF (16.2%) than those with HFmrEF ( vs 26.9%,p = 0.034) and HFrEF ( vs 31.3%,p < 0.001). At 10 years, mortality rates in HFpEF group (58.0%) remained lower than HFmrEF group ( vs 71.0%,p = 0.38), but similar to HFrEF group ( vs 55.8%,p = 0.651).ConclusionsIn Chinese with type 2 diabetes, HFpEF was the predominant HF subtype. One-year mortality following decompensated HF was lowest in HFpEF group but 10-year mortality was similar between HFpEF and HFrEF.