Heart Failure Therapy in Diabetic Patients-comparison with the Recent ESC/EASD Guideline

Overview

Journal Cardiovasc Diabetol

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
Endocrinology

Date 2011 Feb 10

PMID 21303531

Citations 3

Authors

Frank Edelmann

Rolf Wachter

Hans-Dirk Dungen

Stefan Stork

Annette Richter

Raoul Stahrenberg

Till Neumann

Claus Luers

Christiane E Angermann

Felix Mehrhof

Gotz Gelbrich

Burkert Pieske

Affiliations

Soon will be listed here.

Abstract

Background: To assess heart failure therapies in diabetic patients with preserved as compared to impaired systolic ventricular function.

Methods: 3304 patients with heart failure from 9 different studies were included (mean age 63 ± 14 years); out of these, 711 subjects had preserved left ventricular ejection fraction (≥ 50%) and 994 patients in the whole cohort suffered from diabetes.

Results: The majority (>90%) of heart failure patients with reduced ejection fraction (SHF) and diabetes were treated with an ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) or with beta-blockers. By contrast, patients with diabetes and preserved ejection fraction (HFNEF) were less likely to receive these substance classes (p < 0.001) and had a worse blood pressure control (p < 0.001). In comparison to patients without diabetes, the probability to receive these therapies was increased in diabetic HFNEF patients (p < 0.001), but not in diabetic SHF patients. Aldosterone receptor blockers were given more often to diabetic patients with reduced ejection fraction (p < 0.001), and the presence and severity of diabetes decreased the probability to receive this substance class, irrespective of renal function.

Conclusions: Diabetic patients with HFNEF received less heart failure medication and showed a poorer control of blood pressure as compared to diabetic patients with SHF. SHF patients with diabetes were less likely to receive aldosterone receptor blocker therapy, irrespective of renal function.

Citing Articles

Medical recommender systems based on continuous-valued logic and multi-criteria decision operators, using interpretable neural networks.

Diaz Ochoa J, Csiszar O, Schimper T BMC Med Inform Decis Mak. 2021; 21(1):186.

PMID: 34112161 PMC: 8194023. DOI: 10.1186/s12911-021-01553-3.

β-Blocker Doses and Heart Rate in Patients with Heart Failure: Results from the National Norwegian Heart Failure Registry.

Eriksen-Volnes T, Westheim A, Gullestad L, Slind E, Grundtvig M Biomed Hub. 2020; 5(1):9-18.

PMID: 32775329 PMC: 7383246. DOI: 10.1159/000505474.

Seven-year mortality in heart failure patients with undiagnosed diabetes: an observational study.

Flores-Le Roux J, Comin J, Pedro-Botet J, Benaiges D, Puig-de Dou J, Chillaron J Cardiovasc Diabetol. 2011; 10:39.

PMID: 21569580 PMC: 3125195. DOI: 10.1186/1475-2840-10-39.

References

Mehrhof F, Loffler M, Gelbrich G, Ozcelik C, Posch M, Hense H . A network against failing hearts--introducing the German "Competence Network Heart Failure". Int J Cardiol. 2009; 145(1):135-8. DOI: 10.1016/j.ijcard.2009.06.061. View

Kannel W, Hjortland M, CASTELLI W . Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol. 1974; 34(1):29-34. DOI: 10.1016/0002-9149(74)90089-7. View

Stahrenberg R, Edelmann F, Mende M, Kockskamper A, Dungen H, Scherer M . Association of glucose metabolism with diastolic function along the diabetic continuum. Diabetologia. 2010; 53(7):1331-40. PMC: 2877336. DOI: 10.1007/s00125-010-1718-8. View

Ryden L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer M . Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J. 2007; 28(1):88-136. DOI: 10.1093/eurheartj/ehl260. View

Pitt B, Zannad F, Remme W, Cody R, CASTAIGNE A, Perez A . The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999; 341(10):709-17. DOI: 10.1056/NEJM199909023411001. View

MacDonald M, Petrie M, Varyani F, Ostergren J, Michelson E, Young J . Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J. 2008; 29(11):1377-85. DOI: 10.1093/eurheartj/ehn153. View

Komajda M, Follath F, Swedberg K, Cleland J, Aguilar J, Cohen-Solal A . The EuroHeart Failure Survey programme--a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J. 2003; 24(5):464-74. DOI: 10.1016/s0195-668x(02)00700-5. View

Lloyd-Jones D, Larson M, Leip E, Beiser A, DAgostino R, Kannel W . Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation. 2002; 106(24):3068-72. DOI: 10.1161/01.cir.0000039105.49749.6f. View

OKeefe J, Abuissa H, Pitt B . Eplerenone improves prognosis in postmyocardial infarction diabetic patients with heart failure: results from EPHESUS. Diabetes Obes Metab. 2007; 10(6):492-7. DOI: 10.1111/j.1463-1326.2007.00730.x. View

10.

Pocock S, Wang D, Pfeffer M, Yusuf S, McMurray J, Swedberg K . Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J. 2005; 27(1):65-75. DOI: 10.1093/eurheartj/ehi555. View

11.

Solomon S, Janardhanan R, Verma A, Bourgoun M, Daley W, Purkayastha D . Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction: a randomised trial. Lancet. 2007; 369(9579):2079-87. DOI: 10.1016/S0140-6736(07)60980-5. View

12.

Taubert G, Bergmeier C, Andresen H, Senges J, Potratz J . Clinical profile and management of heart failure: rural community hospital vs. metropolitan heart center. Eur J Heart Fail. 2001; 3(5):611-7. DOI: 10.1016/s1388-9842(01)00142-8. View

13.

Bhatia R, Tu J, Lee D, Austin P, Fang J, Haouzi A . Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006; 355(3):260-9. DOI: 10.1056/NEJMoa051530. View

14.

Owan T, Hodge D, Herges R, Jacobsen S, Roger V, Redfield M . Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006; 355(3):251-9. DOI: 10.1056/NEJMoa052256. View

15.

Nardi E, Palermo A, Mule G, Cusimano P, Cottone S, Cerasola G . Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease. J Hum Hypertens. 2010; 25(3):144-51. DOI: 10.1038/jhh.2010.96. View

16.

Juurlink D, Mamdani M, Lee D, Kopp A, Austin P, Laupacis A . Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med. 2004; 351(6):543-51. DOI: 10.1056/NEJMoa040135. View

17.

Desai A, Swedberg K, McMurray J, Granger C, Yusuf S, Young J . Incidence and predictors of hyperkalemia in patients with heart failure: an analysis of the CHARM Program. J Am Coll Cardiol. 2007; 50(20):1959-66. DOI: 10.1016/j.jacc.2007.07.067. View

18.

Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B . Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003; 348(14):1309-21. DOI: 10.1056/NEJMoa030207. View

19.

Cleland J, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J . The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J. 2006; 27(19):2338-45. DOI: 10.1093/eurheartj/ehl250. View

20.

Pitt B, Bakris G, Ruilope L, DiCarlo L, Mukherjee R . Serum potassium and clinical outcomes in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Circulation. 2008; 118(16):1643-50. DOI: 10.1161/CIRCULATIONAHA.108.778811. View