Comorbidity in patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction. Cluster analysis of the RICA registry. Opportunities for improvement

Abstract Aim The heterogeneity of patients with heart failure and preserved ejection fraction (HFpEF) is high, thus this entity tends to be grouped into phenotypes to act with precision. Within these groups, patients with type 2 diabetes mellitus (DM2) hold this heterogeneity. Our aim is to describe subgroups of patients with HFpEF and DM2 based on other comorbidities. Material and methods Patients were recruited from the national registry of heart failure (RCIA). Patients with ejection fraction greater than or equal to 50% without valvular disease and with DM2 were included. A hierarchical agglomerative analysis was performed with Ward's method including the following variables: dyslipidemia, liver disease, Chronic obstructive pulmonary disease (COPD), dementia, cerebrovascular disease, arrhythmia, systolic blood pressure, body mass index (BMI), estimation of glomerular filtration and hemoglobin. Results A total of 1934 patients with HFpEF were included, of which 907 (46.9%) had DM2 with a predominance of women (60.9%) and with a BMI of 31.1 (5.9) Kg/m2. Four groups were obtained, two with high vascular risk (one with arrhythmia and the other without it) with 263 patients the first and 201 the second. A third group had a predominance of COPD (140 patients) and a last group with 303 patients older but with less comorbidity. Conclusions In our patients with HFpEF and DM2, obesity and female sex predominated. All four groups offered treatment chances to improve their prognosis not only based on the use of new antidiabetic drugs but also on other options that may be a starting point for further research