Abstract
Undetected heart failure appears to be an important health problem in patients with type 2 diabetes and aged ≥ 60 years. The prevalence of previously unknown heart failure in these patients is high, steeply rises with age, and is overall higher in women than in men. The majority of the patients with newly detected heart failure have a preserved ejection fraction. A diagnostic algorithm to detect or exclude heart failure in these patients with variables from the medical files combined with items from history taking and physical examination provides a good to excellent accuracy. Annual screening appears to be cost-effective. Both unrecognised heart failure with reduced and with preserved ejection fraction were associated with a clinically relevant lower health status in patients with type 2 diabetes. Also the prognosis of these patients was worse than of those without heart failure. Existing disease-management programs for type 2 diabetes pay insufficient attention to early detection of cardiovascular diseases, including heart failure. We conclude that more attention is needed for detection of heart failure in older patients with type 2 diabetes.
Highlights
At present, disease management of patients with type 2 diabetes (T2DM) is mainly focussed on glucose regulation, blood pressure and lipid control, prevention of diabetic ulcers, and the early detection of specific micro-vascular problems, typically albuminuria and retinopathy
Heart failure with preserved ejection fraction (HFpEF) is expected to be highly prevalent, because in the early stages of this subtype of heart failure, symptoms often only occur after exercise, and signs of fluid retention can be inconspicuous
The risk of remaining undetected and being wrongly labelled as e.g. chronic obstructive pulmonary disease (COPD) is high for heart failure with preserved ejection fraction (HFpEF), the more because echocardiography is not readily available in primary care, while echocardiography is essential for establishing the diagnosis of HFpEF
Summary
Disease management of patients with type 2 diabetes (T2DM) is mainly focussed on glucose regulation, blood pressure and lipid control, prevention of diabetic ulcers, and the early detection of specific micro-vascular problems, typically albuminuria and retinopathy. Patients with more than three points have a higher risk of heart failure of more than 20 % Both electrocardiography and natriuretic peptides had independent added value beyond the clinical model and increased the C-statistic to 0.86; 95 % CI 0.83–0.89 [3]. Already at the time of screening, both screen-detected HFrEF and HFpEF were associated with a clinically relevant lower health status than patients with T2DM without heart failure. This persisted during the 1-year follow-up period. The hazard ratio adjusted for age and gender for the combined endpoint of all-cause mortality and cardiac hospitalisations was 3.7 (95 % CI 2.2–6.3) for HFrEF and 1.5 (95 % CI 1.0–2.2) for HFpEF compared with those without screen-detected heart failure [6]. Other drugs, including beta-blockers, angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers and mineralo-corticoid inhibitors have been tested in ran-
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