Sun, LY, Zghebi, SS, Bader Eddeen, A, Liu, PP, Lee, DS, Tu, K, Tobe, SW, Kontopantelis, E and Mamas, M (2022) Derivation and External Validation of a Clinical Model to Predict Heart Failure Onset in Patients with Incident Diabetes. Diabetes Care, 45 (11). pp. 2737-2745. ISSN 0149-5992

[thumbnail of Diabetes HF validation _Diabetes_Care_clean.docx] Text
Diabetes HF validation _Diabetes_Care_clean.docx - Accepted Version

Download (163kB)
[thumbnail of Online-only Supplement file.docx] Text
Online-only Supplement file.docx - Supplemental Material

Download (606kB)
[thumbnail of dc220894.pdf]
dc220894.pdf - Published Version

Download (692kB) | Preview



Heart failure (HF) often develops in patients with diabetes and is recognized for its role in increased cardiovascular morbidity and mortality in this population. Most existing models predict risk in patients with prevalent rather than incident diabetes and fail to account for sex differences in HF risk factors. We derived sex-specific models in Ontario, Canada to predict HF at diabetes onset and externally validated these models in the U.K.


Retrospective cohort study using international population-based data. Our derivation cohort comprised all Ontario residents aged >= 18 years who were diagnosed with diabetes between 2009 and 2018. Our validation cohort comprised U.K. patients aged >= 35 years who were diagnosed with diabetes between 2007 and 2017. Primary outcome was incident HF. Sex-stratified multivariable Fine and Gray subdistribution hazard models were constructed, with death as a competing event.


A total of 348,027 Ontarians (45% women) and 54,483 U.K. residents (45% women) were included. At 1, 5, and 9 years, respectively, in the external validation cohort, the C-statistics were 0.81 (95% CI 0.79-0.84), 0.79 (0.77-0.80), and 0.78 (0.76-0.79) for the female-specific model; and 0.78 (0.75-0.80), 0.77 (0.76-0.79), and 0.77 (0.75-0.79) for the male-specific model. The models were well-calibrated. Age, rurality, hypertension duration, hemoglobin, HbA(1c), and cardiovascular diseases were common predictors in both sexes. Additionally, mood disorder and alcoholism (heavy drinker) were female-specific predictors, while income and liver disease were male-specific predictors.


Our findings highlight the importance of developing sex-specific models and represent an important step toward personalized lifestyle and pharmacologic prevention of future HF development.

Item Type: Article
Additional Information: © 2022 by the American Diabetes Association Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC660 Diabetes
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Depositing User: Symplectic
Date Deposited: 22 Aug 2022 15:14
Last Modified: 14 Apr 2023 08:59

Actions (login required)

View Item
View Item