Heart failure with microvascular dysfunction: Insights from a propensity-matched analysis of diabetic retinopathy in heart failure with reduced ejection fraction.

BACKGROUND

Diabetic retinopathy, a microvascular complication of diabetes, is a significant marker of systemic vascular damage, which has been linked to increased cardio-renal disease risks. This study investigates the impact of diabetic retinopathy on all-cause mortality and adverse cardiovascular and renal outcomes in patients with established heart failure with reduced ejection fraction (HFrEF) using real-world data.

METHODS

Using data from January 1, 2012, to December 31, 2021, we conducted a propensity-matched analysis of two cohorts of patients with HFrEF and diabetes without chronic kidney disease (CKD, estimated glomerular filtration rate >60 mL/min/1.73 m²), differentiated by the presence or absence of diabetic retinopathy diagnosis in the TriNetX platform. The primary outcome was all-cause mortality, with secondary outcomes including acute HF, CKD progression, major adverse cardiovascular events, stroke, in-patient hospitalizations, venous thromboembolism (VTE), and peripheral arterial disease (PAD).

RESULTS

Following propensity score matching across demographics and clinical variables, each cohort included 15,218 patients. Acute HF was more common in the retinopathy vs non-retinopathy cohort (HR: 1.13, 95 % CI: 1.06-1.20). Results also showed significant increased risks for CKD progression (HR: 1.39, 95 % CI: 1.30-1.50), stroke (HR: 1.18, 95 % CI: 1.08-1.28), as well as PAD (HR: 1.58, 95 % CI: 1.42-1.76) for patients with diabetic retinopathy.

CONCLUSION

Diabetic retinopathy is associated with an increased risk of adverse cardio-renal outcomes in patients with established HFrEF.