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Heart failure therapy in diabetic patients-comparison with the recent ESC/EASD guideline

Frank Edelmann1, Rolf Wachter, Hans-Dirk Düngen

  • 1Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany. fedelmann@med.uni-goettingen.de

Cardiovascular Diabetology
|February 10, 2011
PubMed

Insights

Diabetic patients with heart failure and preserved ejection fraction (HFNEF) received less heart failure medication and had poorer blood pressure control compared to those with reduced ejection fraction (SHF). Diabetic SHF patients were less likely to receive aldosterone receptor blockers.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Heart failure (HF) management differs between patients with preserved ejection fraction (HFNEF) and reduced ejection fraction (SHF).
  • Diabetes mellitus is a significant comorbidity impacting HF prognosis and treatment.
  • Limited data exists on comparative HF therapies in diabetic patients stratified by ejection fraction.

Purpose of the Study:

  • To compare the utilization of heart failure therapies in diabetic patients with HFNEF versus SHF.
  • To assess blood pressure control and medication adherence across diabetic HF subgroups.

Main Methods:

  • A meta-analysis of 9 studies involving 3304 heart failure patients.
  • Subgroup analysis of 711 patients with HFNEF (ejection fraction ≥ 50%) and 994 diabetic patients.
  • Comparison of ACE inhibitor/ARB, beta-blocker, and aldosterone receptor blocker (ARB) prescription rates.

Main Results:

  • Diabetic HFNEF patients were less likely to receive ACE inhibitors, ARBs, or beta-blockers and had poorer blood pressure control than diabetic SHF patients.
  • Diabetic HFNEF patients were more likely to receive these therapies compared to non-diabetic HFNEF patients.
  • Diabetic SHF patients were less likely to receive aldosterone receptor blockers, with increased diabetes severity decreasing prescription probability.

Conclusions:

  • Diabetic patients with HFNEF experience suboptimal medical management and poorer blood pressure control compared to diabetic SHF patients.
  • Diabetic SHF patients face barriers in receiving aldosterone receptor blocker therapy, irrespective of renal function.
Abstract

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