Incidence and outcomes of diabetes mellitus amongst hospital admissions with de novo heart failure; a retrospective cohort study from a nationwide registry

Background Diabetes Mellitus (DM) is a recognized risk factor for the development of acute and chronic heart failure (HF). De Novo HF (DNHF), defined as acute HF occurring in patients with no prior history of HF, is a distinct type which is usually seen in patients with established cardiovascular risk factors such as DM. However, in some cases, DNHF may be the initial manifestation of DM and lead to a new diagnosis of DM during admission for HF symptoms. The incidence of this occurrence is under-recognized in the setting of DNHF. Our study aimed to determine the incidence of newly diagnosed DM in patients presenting with DNHF and to determine any differences in clinical characteristics or short-term outcomes across the spectrum of DM. Methods This retrospective cohort study was conducted at the largest advanced HF center in Qatar. All patients admitted with DNHF were grouped as: 1) newly diagnosed DM, 2) pre-existing DM, 3) prediabetes, and 4) no DM. Clinical characteristics and in-hospital/post-discharge outcomes were described. Continuous variables were reported as mean with standard deviation or IQR and categorical variables as frequency distribution with percentage. Results Among 260 patients with DNHF, 173 (66.5%) had DM, and 52 (20%) were prediabetic. Newly diagnosed DM was identified in 26 (10%), 147 (56.5%) were known diabetics. Compared with known DM, newly diagnosed patients were predominantly male (92.3% vs . 74.1%), had fewer comorbidities such as hypertension (84.6% vs . 90.5%), coronary artery disease (57.7% vs 79.6%), chronic kidney disease (11.5% vs . 29.9%), had a greater non-ischemic etiology of HF (30.4% vs . 23.2%), and higher prevalence of HFrEF (92.3% vs 70.3%). In-hospital mortality and readmissions were similar across all groups. Conclusion Our findings indicate the high burden of dysglycemia (DM and prediabetes) that is present in DNHF patients. Furthermore, DNHF served as the initial clinical presentation of DM or prediabetes in approximately one-third of our patients. This underscores the need for routine metabolic screening in patients presenting with DNHF, as early identification and management of DM is crucial in this population to improve outcomes.