TOPLINE

Among patients with type 2 diabetes (T2D), heart failure (HF) recorded during hospitalisation was associated with greater functional dependence and more severe renal impairment, whereas HF recorded in primary care often involved older patients with a higher comorbidity burden and greater functional independence.

METHODOLOGY

• Researchers in Spain conducted a retrospective cohort study using linked health records (2010-2023) to identify clinical factors associated with an HF diagnosis recorded in primary care or during hospitalisation among patients with T2D and to compare functional status by the diagnostic setting.
• The cohort included 58,202 patients with T2D and HF (mean age, 72.6 years; 46.6% men), with an HF diagnosis recorded in primary care alone (n = 33,637), hospitalisation alone (n = 11,691), or both settings (n = 12,847).
• At baseline, recorded data included demographics; lifestyle and socioeconomic factors; comorbidities (hypertension, dyslipidaemia, chronic kidney disease, stroke, coronary heart disease, atrial fibrillation, and microvascular/macrovascular complications); body measurements; and laboratory parameters.
• The Charlson Comorbidity Index was calculated, and functional dependency was assessed using the Barthel Index, with lower scores indicating greater dependence.

TAKEAWAY

• Among patients with T2D and HF, profiles differed by setting: Those with an HF diagnosis recorded during hospitalisation were younger, more often men, and more functionally dependent with lower comorbidity, whereas those with an HF diagnosis recorded in primary care had more atrial fibrillation.
• Hypertension was a strong predictor of a recorded HF diagnosis in both settings, with a markedly higher risk seen in hospitalisation records than in primary care records (hazard ratio [HR], 12.08; P = .013 vs HR, 5.16; P = .005).
• In hospitalisation-recorded diagnoses, lower Barthel Index scores were associated with a higher risk for HF (HR, 0.99; P < .001). Larger abdominal circumference was also associated with an increased risk for hospitalisation‑recorded HF (HR, 1.02; P < .001). None of these associations were observed in primary care-recorded diagnoses.
• Patients with a glomerular filtration rate above 30 mL/min/1.73 m² showed a lower risk for a recorded HF diagnosis during hospitalisation than those with severe renal impairment (< 30 mL/min/1.73 m²).

IN PRACTICE

"[The study] findings may reflect differences in healthcare pathways, timings of diagnosis as well as data capture systems, and highlight the need for integrated care pathways between primary care and hospital settings for patients with T2D," the authors of the study wrote.

SOURCE

The study was led by Josep Anton-Riera, Institut Català de la Salut, Barcelona, Spain. It was published online on July 06, 2026, in Primary Care Diabetes.

LIMITATIONS

The misclassification of HF cannot be ruled out. The limited availability of natriuretic peptide testing and echocardiography in primary care may have contributed to diagnostic differences between primary care and hospital records. Residual confounding from unmeasured factors may have influenced the results.

DISCLOSURES

This study was supported by the Carlos III Institute of Health, Ministry of Economy and Competitiveness, Spain. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.