The impact of misdiagnosed heart failure and cardiac or extra-cardiac disease burden on the prognosis in patients with type 2 diabetes.

BACKGROUND

We examined how misdiagnosed heart failure (HF) and the burden of cardiac and extra-cardiac diseases prognostically impact 1-year outcomes (all-cause mortality, rehospitalization, and their composite) in patients with type 2 diabetes mellitus (T2DM).

METHODS

A retrospective analysis of a prospective observational cohort study was performed. This study included 1008 patients with T2DM. Misdiagnosis of HF was defined as the difference between the diagnosis of HF contained in the primary care medical records of the patient upon admission and the final diagnosis established in the hospital at discharge. We used the MAGGIC risk score. Univariate and multivariate Cox proportional hazard models were used.

RESULTS

In the subgroup with misdiagnosed HF, multivariate Cox regression analysis showed that the MAGGIC noncardiac burden was the most significant predictor of the composite outcome (adjusted HR: 1.217 [1.079-1.461]; p < 0.001, and adjusted HR: 1.305 [1.119-1.561]; p < 0.001) during the 1-year follow-up.

CONCLUSIONS

This longitudinal study highlights that the misdiagnosis of heart failure, both under- and overdiagnosis, is common in T2DM patients and is associated with worse long-term outcomes, even after receiving appropriate hospital-based management.