The WATCH-DM risk score estimates clinical outcomes in type 2 diabetic patients with heart failure with preserved ejection fraction
Authors: Iwakura Katsuomi , Onishi Toshinari , Okamura Atsunori , Koyama Yasushi , Tanaka Nobuaki , Okada Masato , Fujii Kenshi , Seo Masahiro , Yamada Takahisa , Yano Masamichi , Hayashi Takaharu , Yasumura Yoshio , Nakagawa Yusuke , Tamaki Shunsuke , Nakagawa Akito , Sotomi Yohei , Hikoso Shungo , Nakatani Daisaku , Sakata Yasushi ,   PURSUIT-HFpEF Investigators, Watanabe Tetsuya , Higuchi Yoshiharu , Masuda Masaharu , Asai Mitsutoshi , Mano Toshiaki , Fuji Hisakazu , Masuda Daisaku , Shutta Ryu , Yamashita Shizuya , Sairyo Masami , Abe Haruhiko , Ueda Yasunori , Matsumura Yasushi , Nagai Kunihiko , Nishino Masami , Tanouchi Jun , Arita Yoh , Ogasawara Nobuyuki , Ishizu Takamaru , Ichikawa Minoru , Takano Yuzuru , Rin Eisai , Shinoda Yukinori , Tachibana Koichi , Hoshida Shiro , Izumi Masahiro , Yamamoto Hiroyoshi , Kato Hiroyasu , Nakatani Kazuhiro , Yasuga Yuji , Nishio Mayu , Hirooka Keiji , Yoshimura Takahiro , Kashiwase Kazunori , Hasegawa Shinji , Tani Akihiro , Okumoto Yasushi , Makino Yasunaka , Kijima Yoshiyuki , Kitao Takashi , Fujita Masashi , Harada Koichiro , Kumada Masahiro , Nakagawa Osamu , Araki Ryo , Yamada Takayuki , Matsuoka Yuki , Sato Taiki , Sunaga Akihiro , Oeun Bolrathanak , Kida Hirota , Dohi Tomoharu , Akazawa Yasuhiro , Nakamoto Kei , Okada Katsuki , Sera Fusako , Kioka Hidetaka , Ohtani Tomohito , Takeda Toshihiro , Mizuno Hiroya 
Published: January 2024

The coexistence of heart failure is frequent and associated with higher mortality in patients with type 2 diabetes (T2DM), and its management is a critical issue. The WATCH-DM risk score is a tool to predict heart failure in patients with type 2 diabetes mellitus (T2DM). We investigated whether it could estimate outcomes in T2DM patients with heart failure with preserved ejection fraction (HFpEF). The WATCH-DM risk score was calculated in 418 patients with T2DM hospitalized for HFpEF (male 49.5%, age 80 ± 9 years, HbA1c 6.8 ± 1.0%), and they were divided into the “average or lower” (≤ 10 points), “high” (11–13 points) and “very high” (≥ 14 points) risk groups. We followed patients to observe all-cause death for 386 days (median). We compared the area under the curve (AUC) of the WATCH-DM score for predicting 1-year mortality with that of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score and of the Barcelona Bio-Heart Failure Risk (BCN Bio-HF). Among the study patients, 108 patients (25.8%) had average or lower risk scores, 147 patients (35.2%) had high risk scores, and 163 patients (39.0%) had very high risk scores. The Cox proportional hazard model selected the WATCH-DM score as an independent predictor of all-cause death (HR per unit 1.10, 95% CI 1.03 to 1.19), and the “average or lower” risk group had lower mortality than the other groups (p = 0.047 by log-rank test). The AUC of the WATCH-DM for 1-year mortality was 0.64 (95% CI 0.45 to 0.74), which was not different from that of the MAGGIC score (0.72, 95% CI 0.63 to 0.80, p = 0.08) or that of BCN Bio-HF (0.70, 0.61 to 0.80, p = 0.25). The WATCH-DM risk score can estimate prognosis in T2DM patients with HFpEF and can identify patients at higher risk of mortality.