HFpEF prevalence among individuals with type 2 diabetes mellitus in a primary care setting: A matter of definitions (Early-HFpEF cohort profile)

Aims People with type 2 diabetes (T2D) have an increased risk of heart failure (HF), particularly HF with preserved ejection fraction (HFpEF). This study compared HFpEF prevalence using four common definitions and examined echocardiographic abnormalities in T2D patients in primary care. Methods We analyzed 844 T2D individuals without known HF from the Dutch Diabetes Care System cohort. Symptoms were assessed by questionnaire and physical exam. Transthoracic echocardiography and NT-proBNP measurements were performed. HFpEF prevalence was determined according to the ESC 2021, NHG 2024, H₂FPEF, and HFA-PEFF algorithms. Results ESC-defined HFpEF prevalence was 37%, largely driven by a high prevalence of E/e′ ' 9. Using a higher E/e′ threshold ('14) reduced prevalence to 30%. ESC-HFpEF patients were more often female (49% vs. 31%) and had higher BMI (31.8 vs. 28.5 kg/m²). NHG-defined HFpEF prevalence was 12%. H₂FPEF and HFA-PEFF scores classified 4% and 12% as HFpEF, respectively, with approximately 80% of patients classified as intermediate risk by these scores. Conclusions Discrepancies in HFpEF prevalence were observed across the four algorithms. The ESC-guideline identified a high prevalence, suggesting low discrimination, while the NHG guideline showed low sensitivity. The ESC algorithm with a higher E/e′ threshold may be most appropriate for this population.