Type 2 Diabetes and Heart Failure: The Diagnosis Site Matters

Researchers in Spain conducted a retrospective cohort study using linked health records (2010-2023) to identify clinical factors associated with an HF diagnosis recorded in primary care or during hospitalisation among patients with T2D and to compare functional status by the diagnostic setting.
The cohort included 58,202 patients with T2D and HF (mean age, 72.6 years; 46.6% men), with an HF diagnosis recorded in primary care alone (n = 33,637), hospitalisation alone (n = 11,691), or both settings (n = 12,847).
At baseline, recorded data included demographics; lifestyle and socioeconomic factors; comorbidities (hypertension, dyslipidaemia, chronic kidney disease, stroke, coronary heart disease, atrial fibrillation, and microvascular/macrovascular complications); body measurements; and laboratory parameters.
The Charlson Comorbidity Index was calculated, and functional dependency was assessed using the Barthel Index, with lower scores indicating greater dependence.

Among patients with T2D and HF, profiles differed by setting: Those with an HF diagnosis recorded during hospitalisation were younger, more often men, and more functionally dependent with lower comorbidity, whereas those with an HF diagnosis recorded in primary care had more atrial fibrillation.
Hypertension was a strong predictor of a recorded HF diagnosis in both settings, with a markedly higher risk seen in hospitalisation records than in primary care records (hazard ratio [HR], 12.08; P = .013 vs HR, 5.16; P = .005).
In hospitalisation-recorded diagnoses, lower Barthel Index scores were associated with a higher risk for HF (HR, 0.99; P < .001). Larger abdominal circumference was also associated with an increased risk for hospitalisation‑recorded HF (HR, 1.02; P < .001). None of these associations were observed in primary care-recorded diagnoses.
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