Heart failure documentation in outpatients with diabetes and volume overload: an observational cohort study from the Diabetes Collaborative Registry

Suzanne V Arnold,Leo Seman,Jeanine Cordova,Abhinav Goyal,Michael Beasley,Gregg C Fonarow,Philip G Jones

doi:10.1186/s12933-020-01190-6

Abstract

BackgroundHeart failure is a common and devastating complication of type 2 diabetes (T2D). Prompt recognition of heart failure may avert hospitalization, facilitate use of guideline-directed therapies, and impact choice of T2D medications. We sought to determine the rate and factors associated with heart failure documentation in T2D patients with evidence of volume overload requiring loop diuretics.MethodsDCR is an on-going, prospective US registry of outpatient T2D patients from > 5000 cardiology, endocrinology, and primary care clinicians (current analysis used data from 2013–2019). Among T2D patients receiving loop diuretics, we examined the rate of chart documentation of heart failure. We used a 3-level hierarchical logistic regression model (patients nested within physician within practice) to examine factors associated with heart failure diagnosis.ResultsAmong 1,322,640 adults with T2D, 225,125 (17.0%) were receiving a loop diuretic, of whom 91,969 (40.9%) had documentation of heart failure. Male sex, lower body mass index, atrial fibrillation, chronic kidney disease, and coronary artery disease were associated with greater odds of heart failure diagnosis. After accounting for patient factors, patients seen by cardiologists were the most likely to have HF documented followed by PCPs and then endocrinologists.ConclusionsAmong US outpatients with T2D, 17% of patients had evidence of volume overload—defined by loop diuretic prescription—of whom fewer than half had a clinical diagnosis of heart failure. While there may be non-heart failure indications for loop diuretics, our data suggest that a substantial proportion of T2D patients may have unrecognized heart failure and therefore could be missing opportunities for targeted therapies that could alter the clinical course of heart failure.

Highlights

Heart failure is a common and devastating complication of type 2 diabetes (T2D)
Metformin [5, 6] and sodium–glucose cotransporter-2 (SGLT-2) inhibitors [7, 8] may be beneficial in patients with heart failure (HF) whereas thiazolidinediones [9, 10] and, possibly, some dipeptidyl peptidase-4 inhibitors [11, 12] should be avoided
In order to better define the potential gap in care from a lack of identification of co-morbid HF in outpatients with T2D, we used the Diabetes Collaborative Registry (DCR) to determine the rate and factors associated with HF diagnosis in T2D patients with evidence of volume overload requiring loop diuretics

Summary

Introduction

Prompt recognition of heart failure may avert hospitalization, facilitate use of guideline-directed therapies, and impact choice of T2D medications. We sought to determine the rate and factors associated with heart failure documentation in T2D patients with evidence of volume overload requiring loop diuretics. Use of guideline-directed medical therapy for HF (especially in the setting of left ventricular dysfunction) can substantially reduce the risk of hospitalization and mortality [4]. In order to better define the potential gap in care from a lack of identification of co-morbid HF in outpatients with T2D, we used the Diabetes Collaborative Registry (DCR) to determine the rate and factors associated with HF diagnosis in T2D patients with evidence of volume overload requiring loop diuretics

Methods

Results

Discussion

Conclusion