Abstract Body (Do not enter title and authors here): Background[MR1] : The interplay between diabetes and heart failure (HF) remains unclear in diabetic cardiomyopathy (DCM), a myocardial disorder associated with diabetes mellitus that occurs in the absence of common risk factors such as coronary artery disease (CAD) or hypertension. This study aims to elucidate the distinct characteristics and outcomes of patients with DCM compared to the general HF population (all-cause HF) and a comparable group of patients with HF but no prior diabetes, CAD, or hypertension (HF without risk factors).
Methods: We conducted a case-control study using electronic medical records from the national Veterans Affairs healthcare system (VA). A total of 940,267 all-cause HF patients were identified in the electronic records from 2002 to 2023 using validated algorithms. From this cohort we identified 7,762 patients with DCM and 39,762 patients with HF without risk factors. Baseline characteristics, comorbidities, and outcomes were compared between the groups. Mortality was evaluated using Kaplan-Meier (KM) estimates and Cox proportional hazards models, adjusting for covariates including age, body mass index (BMI), demographics, HF subtype, and comorbidities.
Results: The analysis revealed that DCM cohort developed HF at a significantly younger age than the general HF population (65.5 vs. 70.2 years, p < 0.001). Also, in comparison to the HF without risk factors group, DCM patients had significantly higher BMI (30.7 vs 28, p < 0.001), higher mortality rate (11 vs 9 per 100 person-years), and a significantly higher hazard of death (HR 1.29, 95% CI: 1.25-1.33, p < 0.001). The average total all-cause hospital days per patient per year was also significantly higher in DCM group compared to the HF without risk factors group (15.5 vs. 12.6 days, p < 0.001), whereas this difference was not statistically significant for HF-related hospitalizations.
Conclusion: Our results clearly show that DCM patients experience an earlier onset of HF compared to the general HF population. Furthermore, when compared to HF patients without risk factors, DCM patients exhibit a higher BMI and worse outcomes, including higher all-cause hospitalization rates and a significantly increased risk of mortality. These findings underscore the urgent need for further research to enhance our understanding of DCM and to develop targeted interventions aimed at improving patient outcomes.