3268Impact of heart failure on prognosis compared to other complications in patients with diabetes mellitus type 2

Abstract

Abstract Background Recent studies have highlighted a high incidence of heart failure (HF) in type 2 diabetes mellitus (T2D), but it remains unclear how the development of HF affects prognosis compared to other T2D complications. Purpose To estimate the risk of death associated with the development of HF compared to ischemic heart disease (IHD), chronic kidney disease (CKD), stroke, and peripheral artery disease (PAD). Methods Incident T2D patients were identified in the period between 1998–2015, as all patients redeeming a first-time prescription of non-insulin glucose-lowering medication through Danish nationwide registers. Patients with a history of T2D complications and patients <18 years were excluded. Incident T2D complications were defined as HF, IHD, CKD, stroke, and PAD. We estimated the 5-year risk of death after the development of T2D complications according to the time since the onset of T2D by yearly landmark analyses. We estimated the survival probability and risk ratios (with T2D patients free of complications as reference) at each landmark year among patients who survived their T2D complication. Results A total of 153,403 patients with incident T2D (median age 64 years [interquartile range (IQR):55; 72] and 54% males) were included and followed for a median of 7.4 years (IQR: 4.3; 11.5). During follow-up, 48,087 (31%) patients died. Among the patients who survived, the following number of T2D complications were present at landmark year one vs. ten: HF: 1030 (0.7%) vs. 1082 (2.2%), IHD: 3622 (2.4%) vs. 6354 (12.6%), CKD: 905 (0.6%) vs. 2084 (4.1%), stroke: 1446 (1.0%) vs. 2387 (4.7%) and PAD: 1122 (0.8%) vs. 1517 (3.0%). HF posed the most unfavorable prognosis compared to other T2D complications (see figure). The 5-year risk of death associated with HF development one, five and ten years after T2D diagnosis was: 46.9 (95% confidence interval [CI]: 43.5; 50.3), 47.6 (95% CI: 44.8; 50.3) and 41.8 (95% CI: 38.0; 45.7) respectively. The 5-year risk ratios of death associated with HF development during one, five and ten years after T2D diagnosis compared with T2D patients free of complications was: 3.2 (95% CI, 3.2; 3.3), 3.0 (95% CI 2.9; 3.1) and 2.2 (95% CI, 2.1; 2.2), respectively. Conclusion While IHD was the most common complication at each landmark year, developing HF was associated with the highest risk of death compared to the other T2D complications.