Abstract
BackgroundTo assess heart failure therapies in diabetic patients with preserved as compared to impaired systolic ventricular function.Methods3304 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.ResultsThe 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.ConclusionsDiabetic 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.
Highlights
To assess heart failure therapies in diabetic patients with preserved as compared to impaired systolic ventricular function
Baseline characteristics of the study cohort are displayed in table 1, showing significant differences for most variables according to presence of diabetes or systolic heart failure (SHF)
There were differences how guideline-recommended substance classes were applied in SHF and heart failure and normal ejection fraction (HFNEF) for three important sub-groups: Patients free of diabetes, patients with mild diabetes and patients with severe diabetes [7]
Summary
To assess heart failure therapies in diabetic patients with preserved as compared to impaired systolic ventricular function. Heart failure is a major public health burden and the lifetime risk of developing heart failure in a 40 year old is around 20% [1]. About 50% of patients presenting with heart failure have normal ejection fraction (HFNEF) [2,3]. Recent research revealed that mortality of hospitalized patients with HFNEF is comparable to patients with systolic heart failure (SHF). In most heart failure trials, HFNEF patients were largely underrepresented. Diabetes is a growing epidemiological burden and a major contributor to cardiovascular disease. In male patients with diabetes, the risk to develop heart failure
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