This retrospective cohort study examined risk factors associated with a heart failure (HF) diagnosis recorded in primary care (PC) vs. during hospitalisation among 505,358 adults with incident type 2 diabetes (T2D) in Catalonia (2010–2023), excluding those with prior HF.
Of 58,202 T2D patients with an HF diagnosis, 57.8% were recorded exclusively in PC, 20.1% only in hospitalisation, and 22.1% in both. Functional dependency (Barthel index <60) was a specific predictor of hospital-recorded HF (HR 1.48; 95% CI 1.09–2.02), while older age, high comorbidity burden, hypertension, and atrial fibrillation raised risk in both settings.
- Retrospective design using administrative/registry data (SIDIAP) may introduce coding and ascertainment biases across care settings. - HF diagnosis reflects *recorded* diagnoses, not clinically confirmed incidence — under-coding in PC or hospital may skew comparisons. - Study is limited to Catalonia, potentially limiting generalisability to other health systems.
Functionally dependent T2D patients with renal impairment are more likely to receive an HF diagnosis only during hospitalisation, suggesting they may be missed in routine PC monitoring. Integrated care pathways that link PC and hospital records could improve early HF detection in high-risk T2D patients.
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