Heart failure prevalence and incidence in Aboriginals vs Anglo Celts with type 2 diabetes: The Fremantle Diabetes Study Phase II — ASN Events
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Heart failure prevalence and incidence in Aboriginals vs Anglo Celts with type 2 diabetes: The Fremantle Diabetes Study Phase II (#214)

Timothy ME Davis 1 , Erin Latkovic 2 , Kerry Hunt 2 , Daniel McAullay 3 4 , Wendy A Davis 2
  1. School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, W.A., Australia
  2. School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, W.A., Australia
  3. Kurongkurl Katitjin Centre for Indigenous Australian Education and Research, Edith Cowan University, Mt Lawley, Western Australia, Australia
  4. Australian Primary Health Care Research Institute, Australian National University, Canberra, ACT, Australia

In the general Australian population, heart failure (HF) affects Aboriginal people at younger ages than Caucasians. Whether this applies in type 2 diabetes (T2DM) is unknown. The aim of this study was to compare the prevalence and incidence of HF complicating T2DM in Aboriginals and Anglo-Celts and to determine independent risk factors for incident HF.

The longitudinal observational Fremantle Diabetes Study Phase II includes 105 Aboriginal and 787 Anglo-Celt T2DM subjects who were recruited between 2008 and 2011. This cohort, excluding 66 with prevalent HF, was followed to first hospitalisation or death with HF/death from other causes/census at end-June 2013, a mean follow-up of 3.6±1.1 years.

At baseline, the Aboriginal/Anglo-Celt patients had a mean±SD age of 66.0±11.5 years, 49.5% were male, and their median [inter-quartile range] diabetes duration was 8.5 [2.9-15.4] years.  The Aboriginals were younger (54.2±11.9 vs 67.2±10.6 years) and more often female (65.7% vs 48.9%) than the Anglo-Celts (P≤0.001), and a greater proportion had been hospitalised for HF before recruitment (14.3% vs 6.5%, P=0.008).

Six (6.7%) Aboriginals without prevalent HF at baseline were admitted for HF during 252 years of follow-up (crude incident rate (IR) (95% CI) 23.8 (8.8-51.9) /1,000 patient-years) vs 40 (5.7%) Anglo-Celts during 2,706 years of follow-up (14.8(10.6-20.1) /1,000 patient-years), representing an unadjusted IR ratio of 1.61 (0.56-3.83). The age-adjusted hazard ratio (HR) and 95% CI were 4.03 (1.68-9.68).

In Cox proportional hazards modelling with age as time-line, incident HF hospitalisation was predicted by diabetes duration (HR (95% CI): 1.05 (1.02-1.07) for a 1-year increase), HbA1c (1.48 (1.27-1.72) for a 1% increase), loge(NT-proBNP (pg/mL)) (1.31 (1.07-1.60) for an increase of 1), and Charlson Comorbidity Index (2.20 (1.194-4.04) for a score ≤2; 3.08 (1.56-6.09) for a score ≥3). After adjusting for this most parsimonious model, being Aboriginal increased the risk of incident HF threefold (2.64 (1.16-5.96)).

These Australian community-based data show that, after adjustment for age, diabetes-related factors and co-morbidities, Aboriginals with T2DM had nearly three times the risk of incident HF vs Anglo-Celts. Given the high HF-associated mortality, proactive screening for, and treatment of, HF in Aboriginals with T2DM should be a priority.