Pharmacological treatment patterns and outcomes according to the coexistence of heart failure and Type 2 diabetes: data from the Swedish Heart Failure Registry and National Diabetes Registry.

AIMS: This study aims to assess pharmacological treatment patterns and outcomes according to the coexistence of heart failure (HF) and Type 2 diabetes (T2DM).

METHODS AND RESULTS: Two cohorts were derived: HF patients with/without T2DM and T2DM patients with/without HF, by linking the Swedish HF Registry, the National Diabetes Registry, and other national registries in 2017-2021. In 37 903 patients with HF (35% females, median age 74), T2DM was independently associated with a 10-fold higher use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and less likely use of mineralocorticoid receptor antagonists (MRAs) irrespective of ejection fraction (EF), and of renin-angiotensin inhibitors (RASis)/angiotensin receptor-neprilysin inhibitors (ARNis) in HF with reduced and mildly reduced EF. Over a median follow-up of 1.8 years, T2DM was independently associated with higher risk of first HF hospitalization (HHF)/cardiovascular (CV) death, first HHF, and all-cause death, but not with CV death alone. In 16 266 patients with T2DM (29% females, median age 76), HF was independently associated with more likely use of SGLT2i but less likely use of metformin. Over a median follow-up of 2.2 years, HF was independently associated with higher risk of CV death, all-cause death, and myocardial infarction.

CONCLUSION: In HF, T2DM was associated with higher use of SGLT2i and lower use of MRA and RASi/ARNI despite being linked with a higher risk of death and HHF. In T2DM, presence of HF was linked with higher SGLT2i use and an independent higher risk of death and myocardial infarction. Heart failure was associated with comparatively greater risk increase than T2DM.