Frequency of Undiagnosed Heart Failure in Diabetic Patients Presenting with Diabetic Foot Ulcer (DFU)

Abstract

Background: Diabetes mellitus (DM) is a chronic metabolic disorder that significantly increases the risk of cardiovascular diseases, including heart failure (HF). Diabetic foot ulcer (DFU) is a severe complication of DM, often associated with advanced vascular disease. However, HF remains frequently undiagnosed, particularly in patients with DFU, due to its asymptomatic nature.

Objective: To determine the frequency of undiagnosed heart failure in diabetic patients presenting with diabetic foot ulcers.

Methods: This cross-sectional study was conducted at the Department of Endocrinology, Hayatabad Medical Complex, Peshawar, from June 16th, 2023, to June 15th, 2024. A total of 108 diabetic patients with DFU were enrolled using non-probability consecutive sampling. Patients with a known history of heart failure, ischemic heart disease, or cardiomyopathies were excluded. The diagnosis of DM was confirmed by patient history and fasting blood glucose levels (>130 mg/dL). DFU was clinically diagnosed by the presence of non-healing ulcers on the foot. Heart failure was assessed through clinical examination, echocardiography, and B-type natriuretic peptide (BNP) levels. The severity of DFU was classified using the Wagner classification system. Data analysis was performed using IBM SPSS Statistics version 25.0, with descriptive statistics used to summarize the data and inferential statistics employed for comparisons between groups.

Results: Of the 108 patients, 40 (37.0%) were diagnosed with heart failure, while 68 (63.0%) were without HF. The mean age of the patients was 58.31 ± 10.07 years, with HF patients being older (60.74 ± 9.29 years) than non-HF patients (56.04 ± 11.37 years) (p < 0.05). The HF group had a significantly longer duration of diabetes (15 ± 5 years vs. 10 ± 4 years, p < 0.01) and higher mean HbA1c levels (9.2% ± 1.5% vs. 8.0% ± 1.2%, p < 0.01). Echocardiographic findings showed a lower mean ejection fraction in HF patients (45.54 ± 10.43%) compared to non-HF patients (60.51 ± 5.32%) (p < 0.01). BNP levels were significantly elevated in the HF group (250 ± 50 pg/mL) compared to the non-HF group (100 ± 30 pg/mL) (p < 0.01). The severity of DFU was higher in HF patients, with 53% of HF patients having Wagner grade 3 or higher ulcers compared to 28% in non-HF patients (p < 0.01).

Conclusion: The study identified a high prevalence of undiagnosed heart failure in diabetic patients with DFU, highlighting the need for routine cardiovascular screening in this population. Early detection and management of HF could significantly improve patient outcomes.