In a contemporary cohort of outpatients with type 2 diabetes at high cardiovascular risk but no HF history, only 0.8% had symptomatic heart failure at enrollment, 91.3% had preclinical stage A HF, and 2.8% experienced HF progression over 2 years, while cardiovascular-related healthcare resource utilization remained substantial at 51.68 encounters/100 patient-years.
The prevalence of symptomatic (ACC/AHA stage C) heart failure among T2D patients with high cardiovascular risk but no HF history was very low at 0.8%.
The vast majority of enrolled T2D patients had preclinical (stage A) heart failure at baseline, with a smaller proportion at stage B.
HF progression during the 2-year follow-up period occurred in 2.8% of evaluable patients.
Cardiovascular-related healthcare resource utilization (HCRU) was substantial, affecting more than half of patients during follow-up.
The study cohort consisted predominantly of middle-aged male patients with T2D diagnosed within the prior decade.
The authors interpret the low prevalence of symptomatic HF and low HF-progression rate as likely reflecting effective monitoring and intervention at preclinical HF stages.
This Greek study followed 241 adults with type 2 diabetes (T2D) who had elevated heart disease risk but no known heart failure (HF), tracking them for up to 2 years to understand how common undiagnosed or developing HF is in this population. Researchers found that at the start of the study, only about 1 in 125 patients already had symptomatic heart failure, while the vast majority (over 91%) were in an early, symptom-free 'at risk' stage. Over the follow-up period, only about 3% of patients progressed to a more advanced stage of heart failure, suggesting that current medical management may be reasonably effective at keeping the disease from worsening in the short term. However, despite these relatively low rates of clinical HF, more than half of patients required cardiovascular-related medical encounters during the study, amounting to over 51 healthcare visits per 100 patient-years. This high level of healthcare use — even in patients without overt heart failure — points to a significant ongoing burden on both patients and the healthcare system. The authors suggest this gap between low symptomatic disease rates and high healthcare use highlights an unmet need for better preventive strategies targeted at T2D patients before heart failure becomes symptomatic. This research suggests that people with type 2 diabetes and high cardiovascular risk are frequently engaging with the healthcare system for heart-related reasons even before they develop full-blown heart failure. It underscores the importance of early monitoring and preventive care in this population to potentially reduce future disease progression and healthcare burden. The findings may help inform clinical guidelines and resource planning for managing cardiovascular complications in T2D patients.
Georgiou C, Bistola V, Karavidas A, Vassilikos V, Kanakakis J, Davlouros P, et al.. (2026). Prevalence and evolution of heart failure in patients with type 2 diabetes mellitus at high cardiovascular risk (HF-LANDMARK study).. Journal of diabetes and its complications. https://doi.org/10.1016/j.jdiacomp.2026.109396