Prevalence of Cardiac Autonomic Neuropathy in Diabetic Patients: A Cross-Sectional Study at Bir Hospital, Nepal

Abstract

Background: Cardiac autonomic neuropathy (CAN) is a severe complication of diabetes mellitus characterized by impaired autonomic regulation of the heart, increasing the risk of cardiovascular morbidity and mortality. Objective: To determine the prevalence of cardiac autonomic neuropathy (CAN) in diabetic patients using Ewing’s score and assess the associated clinical factors. Methodology: This cross-sectional study was conducted at NAMS, Bir Hospital, Nepal, from September 2021 to June 2022, involving 100 diabetic patients. CAN was assessed using Ewing’s battery of cardiovascular reflex tests, including heart rate and blood pressure response measurements. Clinical and demographic data were analyzed to identify the prevalence and severity of CAN. Results: Of the 100 diabetic patients, 60% were diagnosed with CAN based on Ewing’s score. Among these, 40% had early-stage CAN, while 20% exhibited severe CAN. Patients with severe CAN had a significantly longer mean duration of diabetes (13.23 ± 7.10 years) compared to those withoutCAN (8.90 ± 5.45 years). Symptom analysis revealed that fatigue (95%), dizziness (90%), and exercise intolerance (80%) were predominant in severe CAN. Ewing’s score reliably categorized patients into normal, early, and severe stages, emphasizing its utility as a diagnostic tool. Conclusion: This study underscores a high prevalence of cardiac autonomic neuropathy in diabetic patients, with Ewing’s score serving as an effective diagnostic framework. Longer diabetes duration and symptom burden were significantly associated with CAN severity. Early detection through Ewing’s tests and routine screening can aid in timely intervention and improved patient outcomes. J Inv Clin Cardiol 2024; 6(2): 43-48