AIMS Impact of type 2 diabetes mellitus (T2DM) on non-thromboembolic outcomes in atrial fibrillation (AF) is insufficiently explored. This prospective cohort study of AF patients aimed (i) to analyse the association between T2DM and heart failure (HF) events (including new-onset HF), and all-cause and cardiovascular mortality, (ii) to assess the impact of baseline T2DM treatment on outcomes, and (iii) to explore characteristics of new-onset HF phenotypes in relation to T2DM status. METHODS AND RESULTS Of 1803 AF patients (515/1288, with/without prior HF), 389 (22%) had T2DM at baseline. After 5 years of median follow-up, T2DM patients had an 85% greater risk of HF events [adjusted hazard ratio (aHR) 1.85; 95% confidence interval (CI) 1.51-2.28; P < 0.001], including a 45% increased risk for new-onset HF (1.45; 1.17-2.28; P = 0.015). T2DM conferred a 56% higher all-cause (1.56, 1.22-2.01; P = 0.003) and a 48% higher cardiovascular mortality (1.48; 1.34-1.93; P = 0.007). Fine-Gray analysis, with mortality as a competing risk, confirmed greater HF risk among T2DM patients. All risks were highest among insulin-treated patients. The prevalence of new-onset HF phenotypes was as follows: 67% preserved ejection fraction (HFpEF), 20% mid-range ejection fraction (HFmrEF) and 13% reduced ejection fraction (HFrEF). On time-dependent Cox regression, adjusted for baseline characteristics and an interim acute coronary event, T2DM increased aHRs for new-onset HFpEF (2.38; 1.30-4.58; P <0.001) and the combined HFmrEF/HFrEF (1.77; 1.11-3.62; P = 0.017). CONCLUSIONS Atrial fibrillation patients with T2DM have independently increased risk of new-onset/recurrent HF events, cardiovascular and all-cause mortality, particularly when insulin-treated. The prevailing phenotype of new-onset HF was HFpEF; T2DM conferred higher risk of both HFpEF and HFmrEF/HFrEF.

中文翻译：

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2型糖尿病增加了心房颤动患者心衰和死亡的长期风险。

目的尚未充分探讨2型糖尿病（T2DM）对房颤（AF）中非血栓栓塞结局的影响。这项针对AF患者的前瞻性队列研究旨在（i）分析T2DM与心力衰竭（HF）事件（包括新发性HF），全因和心血管疾病死亡率之间的关联，（ii）评估基线T2DM的影响治疗方法，以及（iii）探索与2型糖尿病状态相关的新发性HF表型的特征。方法和结果在1803例AF患者（515/1288，有或没有先发HF）中，有389例（22％）在基线时患有T2DM。中位随访5年后，T2DM患者发生HF事件的风险增加了85％[调整后的危险比（aHR）1.85；95％置信区间（CI）1.51-2.28；P <0.001]，包括新发HF的风险增加了45％（1.45; 1.17-2.28; P = 0.015）。T2DM的全因高出56％（1.56，1.22-2.01; P = 0.003），心血管死亡率高48％（1.48; 1.34-1.93; P = 0.007）。用死亡率作为竞争风险的精细灰色分析证实，T2DM患者的HF风险更高。在接受胰岛素治疗的患者中，所有风险最高。新发HF表型的患病率如下：67％的保留射血分数（HFpEF），20％的中程射血分数（HFmrEF）和13％的射血分数减少（HFrEF）。在对时间依赖性Cox回归进行校正基线特征和中期急性冠脉事件后，T2DM增加了新发HFpEF（2.38; 1.30-4.58; P <0.001）和HFmrEF / HFrEF联合（1.77; 1.11-3.62; P = 0.017）。结论T2DM的房颤患者独立发生新发/复发性HF事件的风险增加，心血管和全因死亡率，尤其是在胰岛素治疗下。新发HF的主要表型为HFpEF。T2DM导致HFpEF和HFmrEF / HFrEF的风险更高。