HFpEF as the predominant and underrecognized heart failure phenotype in type 2 diabetes: evidence from the DIABET-IC study

HFpEF as the Predominant and Underrecognized Heart Failure Phenotype in Type 2 Diabetes

Background

Heart failure (HF) is a major complication of type 2 diabetes (T2D). Among HF types, heart failure with preserved ejection fraction (HFpEF) is now the most frequent phenotype. However, its clinical characteristics, prognosis, and treatment compared to heart failure with reduced ejection fraction (HFrEF) remain inadequately described.

Objectives

This study aimed to compare the characteristics, outcomes, and long-term management of HFpEF versus HFrEF in patients with T2D.

Methods

This prespecified subanalysis used data from the nationwide, prospective DIABET-IC cohort, which enrolled 1517 patients with T2D across 58 centers in Spain. Patients were followed for three years. HF phenotypes were classified according to the 2016 ESC guidelines. Baseline features, outcomes (including mortality, hospitalizations, and disease progression), and treatment patterns were evaluated.

Results

At baseline, 490 patients had HF: 50.2% with HFrEF, 30.6% with HFpEF, and 19.2% with heart failure with mid-range ejection fraction (HFmrEF).
Patients with HFpEF were generally older, predominantly female, and showed a higher prevalence of obesity, hypertension, and metabolic syndrome.
In contrast, HFrEF was more frequently linked to ischemic heart disease, prior ST-elevation myocardial infarction (STEMI), and conduction abnormalities.
During follow-up, HFpEF represented the majority of new HF cases (46.6%) and 4.7% of HFpEF patients progressed to HFrEF.
Mortality rates were comparably high in both HFpEF and HFrEF groups.
Hospitalizations for HF tended to be more common in HFrEF, while acute coronary syndromes occurred more often in HFpEF patients.

"HFpEF was the predominant incident phenotype (46.6% of new cases), and 4.7% progressed to HFrEF."

Author’s Summary

HFpEF is a common yet underrecognized heart failure type in type 2 diabetes, linked to specific clinical features and similarly poor outcomes as HFrEF, highlighting the need for tailored management.

BioMed Central — 2025-11-04