Thesis Presentation of the s(rupender).ppt

prevalanve of heart failure with reduced ejection fraction in type 2 dm

1. PREVALENCE OF HEART FAILURE WITH
REDUCED EJECTION FRACTION IN DIABETIC
PATIENTS IN TERTIARY CARE HOSPITAL
Submitted by
Dr. Rupinder Singh
Session: 2022 to 2025,
Department of General Medicine
M.G.M. Medical College & L.S.K. Hospital,
Kishanganj, Bihar
Guide
Prof. (Dr.) Partha Sarthi Karmakar
Department of General Medicine
M.G.M. Medical College & L.S.K. Hospital,
Kishanganj, Bihar

2. RESEARCH OBJECTIVES
Aim
To determine the prevalence of heart failure with reduced ejection fraction in diabetic
patients
Objectives
1.To assess the prevalence of HFrEF among diabetic patients in a specific population of North Bihar.
2.To identify the demographic and clinical characteristics of diabetic patients with HFrEF.
3.To evaluate the association between diabetes-related factors (e.g., duration of diabetes, glycemic control)
and the prevalence of HFrEF.
4.To explore potential risk factors for the development of HFrEF in diabetic patients

3. METHODOLOGY
Type of Study: Follow up & Cohort study
Place of Study: The study was conducted in the department of General Medicine, MGM Medical College &
LSK Hospital Kishanganj, Bihar.
Period of the Study: The study was conducted over a period of 22 months, after getting approval from
Institutional Ethics Committee.
Study Population: Type 2 Diabetic patients aged 30 years and above who are attending the Department of
General Medicine at MGM Medical College & LSK Hospital Kishanganj, Bihar
Gantt chart

4. Sample Size: The sample size was calculated based on the estimated prevalence of HFrEF in diabetic
patients. Assuming a prevalence rate of 15%, a desired level of precision (margin of error) of 5%,
and a confidence level of 95%, the sample size can be calculated using the following formula
n = (Z^2 * P * (1-P)) / E^2
where: n = required sample size Z = Z-score corresponding to the desired confidence level (e.g., 1.96
for 95% confidence level) P = estimated prevalence rate E = desired margin of error
For example, if we use the above values, the sample size calculation will be
n = (1.96^2 * 0.15 * (1-0.15)) / 0.08^2
n= 76.5
The final sample size will be 80

5. Inclusion Criteria:
1.Adult patients aged >45 years and above.
2.Patients with a documented diagnosis of type 2 diabetes mellitus.
3.Patients who provide informed consent to participate in the study
Exclusion Criteria:
1.Patients with a known history of heart failure with preserved ejection fraction (HFpEF).
2.Patients with significant valvular heart disease or congenital heart disease.
3.Patients with severe renal impairment (estimated glomerular filtration rate <30 mL/min/1.73m^2).
4.Patients with significant chronic lung disease or chronic obstructive pulmonary disease (COPD).
5.Patients with a history of myocardial infarction or coronary artery bypass grafting.
6.Patients with a history of malignancy or other serious comorbidities that may limit their life expectancy.
7.Patients who are unable to provide informed consent

6. Statistical Analysis
The data collected in this study can be analyzed using SPSS software (Ver-26). Calculation of
frequencies, proportions, means, and standard deviations to describe the demographic and clinical
characteristics of the study population. The prevalence of heart failure with reduced ejection fraction
(HFrEF) in diabetic patients will be calculated by dividing the number of patients with HFrEF by the
total number of diabetic patients in the study. inferential statistical tests such as chi-square test, t-test,
or logistic regression will be applied

7. RESULTS & ANALYSIS
Figure 1: Demographic Characteristics of
the Study Population
Table 1: Demographic Characteristics of the Study
Population
Variable Category
Number of
Patients (n=80)
Percentage (%)
Age (years)
30-45 25 31.25%
46-60 35 43.75%
>60 20 25.00%
Gender
Male 45 56.25%
Female 35 43.75%
BMI (kg/m²)
<25 (Normal) 30 37.50%
25-30
(Overweight)
35 43.75%
>30 (Obese) 15 18.75%
Demographic Characteristics of the Study Population The study population consisted of 80 diabetic patients. The age
distribution was as follows: 31.25% were aged between 30-45 years, 43.75% were between 46-60 years, and 25%
were over 60 years. In terms of gender, 56.25% were male, and 43.75% were female. Regarding BMI, 37.5% of the
patients had a normal BMI (<25 kg/m²), 43.75% were overweight (BMI 25-30 kg/m²), and 18.75% were obese (BMI
>30 kg/m²)

8. Table 2: Prevalence of HFrEF in Diabetic PatientsFigure 2: Prevalence of HFrEF in Diabetic Patients
Diagnosis
Number of Patients
(n=80)
Percentage (%)
HFrEF (LVEF <
40%)
18 22.50%
No HFrEF (LVEF ≥
40%)
62 77.50%
Prevalence of HFrEF in Diabetic Patients Out of 80 diabetic patients, 22.5% were diagnosed with heart failure with
reduced ejection fraction (HFrEF), characterized by an LVEF < 40%. The remaining 77.5% did not have HFrEF, with
an LVEF ≥ 40%.

9. Table 3: Clinical Characteristics of Diabetic
Patients with HFrEF
Figure 3: Clinical Characteristics of Diabetic Patients
with HFrEF
Variable Category
Number of
Patients (n=18)
Percentage (%)
Duration of
Diabetes
<5 years 5 27.78%
5-10 years 8 44.44%
>10 years 5 27.78%
Glycemic Control
(HbA1c)
<7% (Good
control)
4 22.22%
7-9% (Moderate
control)
8 44.44%
>9% (Poor
control)
6 33.33%
NYHA
Classification
Class I 2 11.11%
Class II 8 44.44%
Class III 6 33.33%
Class IV 2 11.11%
Comorbidities
Hypertension 14 77.78%
Dyslipidemia 10 55.56%
Coronary Artery
Disease (CAD)
8 44.44%
Chronic Kidney
Disease (CKD)
4 22.22%
Clinical Characteristics of Diabetic Patients with HFrEF Among the 18 patients with HFrEF, the duration of diabetes was distributed as
follows: 27.78% had diabetes for less than 5 years, 44.44% for 5-10 years, and 27.78% for more than 10 years. Regarding glycemic control,
22.22% had good control (HbA1c < 7%), 44.44% had moderate control (HbA1c 7-9%), and 33.33% had poor control (HbA1c >9%). In
terms of NYHA classification, 11.11% were classified as Class I, 44.44% as Class II, 33.33% as Class III, and 11.11% as Class IV.
Comorbidities were prevalent in this group: 77.78% had hypertension, 55.56% had dyslipidemia, 44.44% had coronary artery disease (CAD),
and 22.22% had chronic kidney disease (CKD)

10. Table 4: Association Between Diabetes-Related Factors and
HFrEF
Variable Category HFrEF (n=18) No HFrEF (n=62) p-value
Duration of Diabetes
<5 years 5 25
0.045*5-10 years 8 20
>10 years 5 17
Glycemic Control
(HbA1c)
<7% (Good control) 4 30
0.012*
7-9% (Moderate
control)
8 25
>9% (Poor control) 6 7
Association Between Diabetes-Related Factors and HFrEF The table shows the association between diabetes-related
factors and the presence of HFrEF. The duration of diabetes was significantly associated with HFrEF, with a p-value of
0.045. For glycemic control, the HbA1c levels were significantly associated with HFrEF: 30 patients in the "good
control" group did not have HFrEF, while 6 patients with HbA1c >9% (poor control) had HFrEF, and the p-value was
0.012, indicating statistical significance

11. Table 5: Risk Factors for HFrEF in Diabetic Patients
Risk Factor Odds Ratio (OR) 95% Confidence Interval (CI) p-value
Hypertension 3.25 1.45-7.30 0.004*
Dyslipidemia 2.50 1.20-5.20 0.014*
Coronary Artery Disease 4.10 1.80-9.35 0.001*
Chronic Kidney Disease 2.80 1.10-7.15 0.030*
Poor Glycemic Control 3.60 1.65-7.85 0.001*
Risk Factors for HFrEF in Diabetic Patients Several risk factors were identified for HFrEF in diabetic patients.
Hypertension was associated with an odds ratio (OR) of 3.25 (95% CI: 1.45-7.30, p = 0.004), dyslipidemia with
an OR of 2.50 (95% CI: 1.20-5.20, p = 0.014), and coronary artery disease with an OR of 4.10 (95% CI: 1.80-
9.35, p = 0.001), all of which were statistically significant. Additionally, chronic kidney disease (OR = 2.80,
95% CI: 1.10-7.15, p = 0.030) and poor glycemic control (OR = 3.60, 95% CI: 1.65-7.85, p = 0.001) were also
significant risk factors for the development of HFrEF in diabetic patients

12. CURRENT STATUS OF RESULTS

The study has successfully enrolled and collected data from
 
80 diabetic patients 
as per the sample size calculation.

Echocardiography reports, demographic details, clinical characteristics, and laboratory results have been compiled.

The prevalence of HFrEF in diabetic patients is
 
22.5%, which aligns with global estimates.

Risk factors such as
 
hypertension, poor glycemic control, and coronary artery disease 
have been identified as
significant contributors to HFrEF
DIFFICULTIES AND CHALLENGES FACED
Difficulty in recruiting patients who met the inclusion criteria, especially those with complete echocardiography
reports.
Incomplete or missing data in medical records, particularly for laboratory results (e.g., HbA1c, lipid profile).
Variability in echocardiography reports due to differences in equipment or operator expertise

13. POSSIBLE SOLUTIONS
Use electronic medical records (EMRs) to minimize missing or incomplete data.
Collaborate with other departments or hospitals to access additional resources

14. Thank You