Abstract 13998: Glycemic Control and Prognosis in Patients With Type 2 Diabetes Mellitus Hospitalized for Decompensated Heart Failure With Preserve Ejection Fraction

Abstract

Background: In patients with type 2 diabetes mellitus (T2DM), poor glycemic control is associated with higher risk of heart failure (HF) and cardiovascular death. On the other hand, the U-shaped relationship between HbA1c and mortality in T2DM patients with HF was reported by previous studies. The relationship between glycemic control and prognosis in patients with HF with preserved ejection fraction (HFpEF) is not fully elucidated. Methods: We enrolled 345 T2DM patients (80±25 years, Male 48.4%) registered in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction), a multicenter registration of patients hospitalized for decompensated HFpEF, between June 2016 and December 2020 for the present study. We performed echocardiography and measured HbA1c before discharge, and followed patients for median of 388 days (IQR 257-729 days) to observe the major adverse cardiovascular events (MACE; composite of death, HF hospitalization and stroke). We divided patients based on HbA1c into 5 groups (<6.5%, 6.5-6.9%, 7.0-7.5%, 7.5-8.0% and >8.0%). Results: There was no significant difference in age, gender, echocardiographic parameters among the groups. Cox proportional hazard model revealed that age (p=0.01) and HbA1c<6.5% (p=0.01) were independent predictors for MACE, and hazard ratio (HR) for MACE in patients with HbA1c<6.5% was 1.75 (95% CI, 1.10 to 2.77) comparing to those with HbA1c 6.5-6.9%. Patients with HbA1c>8.0% tended to have higher incidence of MACE (p=0.076, HR 1.73 95%CI, 0.94 to 3.17). Conclusions: Among T2DM patients with hospitalized for HFpEF, HbA1c<6.5 was associated with higher incidence of MACE, and there might be U-shaped relationship between HbA1c and MACE incidence.