Clinical profile in type 2 diabetic patients diagnosed of heart failure: differences between primary care and hospital-based records.

Abstract

To examine the risk factors associated with a diagnosis of heart failure (HF) recorded in primary care (PC) or during hospitalisation among patients with type 2 diabetes mellitus (T2D), while taking into consideration the potential influence of diagnostic context and timing of diagnosis. Retrospective cohort study using the Primary Care Information System (SIDIAP database) in Catalonia. The cohort included 505,358 adults with incident T2D (2010-2023) without prior HF. Incident HF was identified from PC registries and hospitalisation discharge reports. Cox regression models were used to identify factors associated with incident HF. Recorded incidence rates were estimated and Kaplan-Meier curves were performed. Among 58,202 patients with T2D and a recorded diagnosis of HF, 11,691 (20.1%) had HF documented only in hospitalisation, 33,637 (57.8%) exclusively in PC and 12,847 (22.1%) in both settings. A higher proportion of patients with an HF diagnosis recorded during hospitalisation had functional dependence (Barthel index <60) and presented with more severe renal impairment. Older age, higher comorbidity burden, hypertension, and atrial fibrillation were associated with an increased risk of a recorded HF diagnosis in both settings. Functional dependency was identified as a predictor of a recorded HF diagnosis in hospitalised patients (hazard ratio 1.48; 95% confidence interval 1.09-2.02). Cumulative hazard curves showed higher rates of HF detection in PC. In primary care, an HF diagnosis was more frequently recorded in older, multimorbid, but functionally independent patients, whereas an HF diagnosis recorded during hospitalisation was more often associated with functional dependence and renal impairment. These findings may reflect differences in healthcare pathways, timings of diagnosis as well as data capture systems, and highlight the need for integrated care pathways between primary care and hospital settings for patients with T2D.