MD Conference Express AHA 2013 - (Page 38)

SELECTED UPDATES ON HEART FAILURE AND DIABETES Managing Patients With Heart Failure and Diabetes Written by Maria Vinall It is currently estimated that 5.1 million adults in the United States have heart failure (HF). By the year 2030, this number is expected to increase by 25%. Over the last several decades, there has also been a marked increase in the prevalence of diabetes [Centers for Disease Control and Prevention. Available at http://www.cdc.gov/diabetes/statistics]. David Aguilar, MD, Baylor College of Medicine, Houston, Texas, USA, discussed the relationship between and coexistence of these two diseases. Diabetes has long been known to amplify the risk for all forms of cardiovascular disease (CVD) and when it develops in patients with HF, it is associated with increased mortality (Table 1) [Cubbon RM et al. Diab Vasc Dis Res 2013; Martinez-Selles M et al. Eur J Heart Fail 2012; MacDonald MR et al. Eur Heart J 2008; From AM et al. Am J Med 2006]. Table 1. Increased Mortality in Patients With HF and Diabetes Mellitus Study Adjusted Risk (95% CI) Population-Based Studies Olmstead County RR, 1.33 (1.07-1.66) United Kingdom HR, 1.72 (1.29-2.28) Clinical trials MAGIC meta-analysis HR, 1.41 (1.35-1.47) CHARM HFrEF HR, 1.55 (1.38-1.74) HFpEF HR, 1.84 (1.51-2.26) HFpEF=heart failure with preserved ejection fraction; HFrEF=heart failure with reduced ejection fraction. Official Peer-Reviewed Highlights From the 38 December 2013 The increased mortality is even more striking among older individuals (aged ≥65 years) with diabetes who go on to develop HF, with such patients having a mortality rate of 32.7/100 personyears compared with similarly aged diabetes patients without HF who have a mortality rate of 3.7/100 person-years (HR, 10.6; 95% CI, 10.4 to 10.9) [Bertoni AG et al. Diabetes Care 2004]. The coexistence of diabetes and HF is also associated with an increased the rate of HF hospitalizations [Shah AM et al. Eur J Heart Fail 2010; MacDonald MR et al. Eur Heart J 2008; Murcia AM et al. Arch Intern Med 2004]. Future studies are needed to better understand the complex interaction of these 2 diseases and to develop treatment strategies to lower the health burden of HF and diabetes, noted Dr. Aguilar. Mary N. Walsh, MD, St. Vincent Heart Center, Indianapolis, Indiana, USA, discussed whether the presence of diabetes should influence the management of patients with HF. Dr. Walsh reinforced diabetes as a driver of HF adding that this is particularly true for women [Levy D et al. JAMA 1996], even among those with no other risk factors and especially when the diabetes is uncontrolled [Bibbins-Domingo K et al. Circulation 2004]. She then asked "Are diabetic patients HF patients?" The answer is "Yes" according to the 2001 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines for the evaluation and management of chronic HF in adults [Hunt SA et al. J Am Coll Cardiol 2001] in which Stage A HF includes patients with diabetes. Whether and how diabetes influences short- and long-term outcomes among patients with HF appears to be related to multiple factors including time, age, and sex. In one study of >116,000 patients (13% with diabetes), diabetes was a significant independent predictor of mortality at 1 year. The longer term risk was greatest in younger patients, particularly women. Diabetes was also a significant independent predictor of readmission for HF, and again, the risk was greatest in younger women [MacDonald M et al. Circ Heart Fail 2008]. www.mdconferencexpress.com http://www.cdc.gov/diabetes/statistics http://www.mdconferencexpress.com

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