Heart failure in type 2 diabetes: results of a non-interventional cross-sectional study in Romania (FIND)

ABSTRACT

Background: Heart failure (HF) is a frequent comorbidity in type 2 diabetes (T2D) patients. Limited data on the prevalence of HF in T2D in Romanian clinical practice exist. Aim: This study addressed this knowledge gap by collecting recent information about HF prevalence in T2D. Method: FIND was a cross-sectional, observational study conducted in two large diabetes outpatient clinics from January to May 2020. Consecutive adult patients with T2D were enrolled upon expressing the written consent. Clinical data related to diabetes status was collected. The cardiology exam was performed as in clinical practice, after inclusion in the study. The cardiac assessment included natriuretic peptide testing, typical HF signs and symptoms, and echocardiography exam with left ventricle ejection fraction (LVEF) and structural abnormalities reported. Due to coronavirus disease-19 lockdown, the study was early terminated and some patients could not perform the cardiology exam. The per protocol population (PPP) included all T2D patients with cardiology exam conducted (270 out of 300 enrolled). Epidemiological methods have been used for the analysis of collected data with descriptive statistics. Results: The prevalence of HF was 30.7%. Most HF patients (83.1%) had preserved ejection fraction (LVEF ≥50%, HFpEF subgroup) and 16.9% mid-range ejection fraction (LVEF 40-49%, HFmrEF subgroup). The prevalence of HF typical symptoms was 57.0% in PPP group and 91.6% in HF subgroup. The echocardiography showed diastolic dysfunction (PPP 87.3%, HF 96.4%), cardiac structural changes (PPP 64.8%, HF 74.7%), and systolic dysfunction (PPP 24.6%, HF 41.0%). Natriuretic peptides were above the upper limit in 23.2% of PPP patients and 57.5% of the HF patients. The gender distribution was balanced (males 50% in PPP, 50.6% in HF group). The mean age (SD) of patients was 63.8 (8.7), and 67.2 (7.8) years, with a mean duration of T2D (SD) of 11.1 (6.9), and 11.7 (7.0) years in PPP and HF groups, respectively. In the HF group, only 8.5% had a previous diagnosis of HF. In total, 98.2% of patients in PPP group received anti-diabetes treatment metformin monotherapy (46.7%), oral anti-diabetes drugs combination (OAD) (26.7%), injectable GLP-1 receptor agonist (GLP-1 RA) (7.4%), and insulin (44.1%). Mean (SD) HbA1c levels were 7.9% (1.6) and 7.8% (1.6) in the PPP and HF groups, respectively. The prevalence of HF by anti-diabetes treatment was 29.6% in metformin only group, 30.6% in OAD group, 20.0% in GLP-1 RA group and 33.6% in insulin group. The treatment for HF following cardiac assessment included beta-blockers (82.4%), diuretics (52.7%), angiotensin converting enzymes inhibitors (47.3%), statins (31.1%), and angiotensin receptor blockers (25.7%). Discussion: FIND is the first study assessing the prevalence of HF in T2D in Romania. Almost one third of patients of the T2D patients had HF diagnosed by a cardiologist and for one in ten patients this was flagged only by the standard cardiologic exam at the time of study. HF prevalence rate was not influenced by diabetes duration or current diabetes treatment. An early clinical assessment of cardiovascular risk followed by tailored treatment approach to ensure cardioprotection and prevent complications is needed. Funding: AstraZeneca Romania.