Comorbidity, hypoglycaemia and appropriate selection of antidiabetic pharmacotherapy in diabetic patients with heart failure in clinical practice in Germany

Abstract Aims The sodium–glucose co-transporter-2 (SGLT2) inhibitors dapagliflozin and empagliflozin have been demonstrated to reduce adverse cardiovascular outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Limited data are available characterizing the generalizability of SGLT2 inhibitors treatment in the clinical practice. The aim of the study was to evaluate the proportion of outpatients with HFrEF that would be eligible for SGLT2 inhibitors in a contemporary real-world population. Methods and results We retrospectively evaluated patients with chronic stable HFrEF followed-up at the HF outpatient clinic of our institution. Patients’ eligibility was assessed according to the entry criteria of DAPA-HF (dapagliflozin) and EMPEROR-Reduced (empagliflozin) trials and to US Food and Drug Administration (FDA) label criteria (only dapagliflozin). A total of 441 HFrEF patients was enrolled. According to the major inclusion and exclusion criteria from DAPA-HF and EMPEROR-Reduced trials, 198 (45%) patients would be candidates for initiation of both dapagliflozin and empagliflozin, 61 (14%) would be eligible only to dapagliflozin and 23 (5%) only to empagliflozin, without significant differences between diabetic and non-diabetic patients (P = 0.23). Among patients not suitable for gliflozins treatment (159 patients; 36%), the major determinant of ineligibility was the failure to achieve the predefined NT-proBNP inclusion threshold. Excluding NTproBNP as per FDA label criteria, dapagliflozin eligibility increased to 86%. Conclusions In our real-world analysis a large proportion of HFrEF patients would be candidates for initiation of SGLT2 inhibitors, supporting its broad generalizability in clinical practice. This would be expected to reduce morbidity and mortality in eligible patients.

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Optimizing Sodium-Glucose Co-transporter 2 Inhibitor Use in Patients with Heart Failure with Reduced Ejection Fraction: A Collaborative Clinical Practice Statement

American Journal of Preventive Cardiology ◽

10.1016/j.ajpc.2021.100183 ◽

2021 ◽

pp. 100183

Author(s):

Bruce A. Warden ◽

Johannes Steiner ◽

Albert Camacho ◽

Khoa Nguyen ◽

Jonathan Q Purnell ◽

...

Keyword(s):

Heart Failure ◽

Clinical Practice ◽

Ejection Fraction ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure

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A Knowledge Translation Framework for Optimizing Physical Therapy in Patients With Heart Failure

Physical Therapy ◽

10.1093/ptj/pzab079 ◽

2021 ◽

Author(s):

Konrad J Dias ◽

Michael J Shoemaker ◽

Kristin M Lefebvre ◽

John D Heick

Keyword(s):

Heart Failure ◽

Clinical Practice ◽

Physical Therapy ◽

Knowledge Translation ◽

Cardiorespiratory Fitness ◽

Practice Guideline ◽

Physical Therapist ◽

Evidence Based ◽

Patients With Heart Failure ◽

The Continuum

Abstract The American Physical Therapy Association (APTA) has supported the development of clinical practice guidelines to promote and support evidence-based practice and reduce unwarranted practice variation. Essential to the success of this effort is the generation of knowledge translation—a concept that emphasizes the translation of global knowledge to an application that can be effectively integrated into clinical practice. The Physical Therapy Clinical Practice Guideline for the Management of Individuals with Heart Failure published in the Physical Therapy Journal in January 2020 provides a broad base of knowledge related to evidence-based treatment interventions for patients with heart failure. However, the application and integration of this knowledge in clinical practice need further elucidation. Therefore, this perspective paper aims to serve as a complementary knowledge translation resource to the recently published practice guideline to maximize the utilization of contemporary evidence in clinical practice. This resource provides the physical therapist with practical guidance in the management of patients with heart failure by placing research findings in the context of other knowledge and practice norms that can be applied at the point of care and across the continuum of care. We propose a novel ABCDE (Assessment, Behavior, Cardiorespiratory Fitness, Dosage, and Education) practical framework. This clinical paradigm is grounded in ongoing physical therapist assessment throughout the episode of care, along with behavior modification, assessment of cardiorespiratory fitness, appropriate selection and dosing of interventions and patient education. Examples highlighting the use of this model in patients with heart failure across the continuum of care are provided for application in clinical care.

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Abstract 13570: Diabetes is Probably Associated With Larger Fluid Retention in Patients With Heart Failure With Preserved Ejection Fraction

Circulation ◽

10.1161/circ.142.suppl_3.13570 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Katsuomi IWAKURA ◽

Toshinari Onishi ◽

Koichi Inoue ◽

Masato Okada ◽

Yasushi Koyama ◽

...

Keyword(s):

Heart Failure ◽

Body Weight ◽

Ejection Fraction ◽

Hospital Stay ◽

Diastolic Pressure ◽

Fluid Retention ◽

Repeated Measure ◽

Diabetic Patients ◽

Preserved Ejection Fraction ◽

Patients With Heart Failure

Introduction: Diabetes is observed in about third of patients with heart failure with preserved ejection fraction (HFpEF), and it is not well elucidated how it would affect the clinical conditions of HFpEF. We investigated the physical and echocardiographic characteristics of diabetes patients in a large-scale, registration study of HFpEF. Methods: We analyzed clinical and echocardiography data obtained at admission and just before hospital discharge in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction), which is a multicenter registration study of patients who were hospitalized for HFpEF. Results: We enrolled 862 patients who were hospitalized for HFpEF between June, 2016 and December, 2019 (Age 81±9 years, male gender 44.5%) for the present study. Diabetes was observed in 287 patients (33.3%), and their age was higher (82±8 years vs. 80±9 years, p=0.003) and body mass index before discharge was larger (23.2±4.7 kg/m2 vs. 21.1±4.6 kg/m2, p<0.0001) than those without diabetes. Diabetic patients had higher body weight at admission (63.2±14.9 kg vs. 55.9±13.4 kg, p<0.0001) and before discharge (56.8±13.3 vs. 50.7±12.1 kg, p<0.0001) than non-diabetic patients. Reduction of body weight during hospital stay was higher in diabetic patients (6.4±4.5 kg) than in non-diabetic patients (5.2±4.0 kg) even after correction of body weight discharge or estimated GFR (p<0.001 by ANCOVA). Body weight reduction was significantly associated with HbA1c (p=0.01). There was no difference in use of intravenous diuretics (69.3% vs. 66.6%, p=0.44) and in hospital stay (21.4±15.3 days vs. 19.9±13.7 days, p=0.14) between diabetic- and non-diabetic patients. Whereas no differences were observed in echocardiographic parameters at admission and before discharge between two arms, the diabetic arm showed significantly higher reduction in septal E/e’ ratio during hospital stay (19.0±8.7 to 17.1±7.6) than non-diabetic arm (16.6±8.3 to 16.4±8.2)(p=0.01 by repeated measure ANOVA). Conclusions: The present study implied that diabetic patients with HFpEF have more fluid retention before hospitalization than non-diabetic ones, which could affect the changes in diastolic pressure.

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Principles of organization of medical care for patients with heart failure in the system of cardiovascular risk management: focus on continuity of care and patient routing. Practical materials

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4558 ◽

2021 ◽

Vol 26 (3S) ◽

pp. 4558 ◽

Cited By ~ 1

Author(s):

S. V. Villevalde ◽

A. E. Soloveva ◽

N. E. Zvartau ◽

N. G. Avdonina ◽

A. N. Yakovlev ◽

...

Keyword(s):

Heart Failure ◽

Risk Management ◽

Clinical Practice ◽

Cardiovascular Risk ◽

Medical Care ◽

Optimal Model ◽

Cardiovascular Risk Management ◽

Patients With Heart Failure ◽

The Russian Federation ◽

Real Clinical Practice

The extent of the problem of heart failure determines the priority of the intention of developing and implementing an optimal model of medical care for this group of patients. The article describes the key components of the heart failure medical care (continuity, patient routing, educational activities) and provides examples of documents, protocols, checklists that can be used in real clinical practice by specialists in medical organizations in the regions of the Russian Federation.

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SUN-611 Impact of Existing Heart Failure on Outcomes of Hospitalization of Hyperosmolar Hyperglycemic State. From the National Inpatient Sample

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.748 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Fatima Ahmed ◽

Ashraf Abugroun ◽

Manar Elhassan ◽

Berhane Seyoum

Keyword(s):

Heart Failure ◽

Mechanical Ventilation ◽

Respiratory Failure ◽

Length Of Stay ◽

Secondary Outcome ◽

Diabetic Patients ◽

National Inpatient Sample ◽

Patients With Heart Failure ◽

Hyperosmolar Hyperglycemic State ◽

The Impact

Abstract Introduction: Patients with underlying heart failure (HF) are at increased risk for hyperosmolar hyperglycemic state (HHS). However, no studies have investigated whether the presence of existing HF would impact the outcomes of HHS. Objective: we aimed to study the impact of heart HF on outcomes of HHS among adult patients hospitalized for HHS. Methodology: The National Inpatient Sample (NIS) was queried for all patients who were admitted with a diagnosis of hyperosmolar hyperglycemic state during the years 2005-2014. The primary outcomes of the study were all-cause mortality, acute myocardial infarction (MI), acute stroke. The secondary outcomes were acute kidney injury (AKI), rhabdomyolysis, acute respiratory failure (ARF), need for mechanical ventilation (MV), length of stay (LOS), and total cost of stay. Results: Overall, 188,725 patients were admitted for hyperosmolar hyperglycemic state. Mean age was 55.9 (SEM: 0.1). Females were (43.9%), Caucasians were 37.4% while African American were 35.2%. Total mortality was 1.1%, MI was 1.3% and stroke was 1.1%. Most common secondary outcome was AKI seen in 31.3% followed by ARF seen in 2.9% of total. The mean cost was 7887 $ (SEM: 84.6) and mean LOS was 4.1 days (SEM: 0.03). Patients with heart failure had higher rates for mortality 2% vs 0.9%, p<0.001, MI 3.1% vs 1.1 % p<0.001 and stroke 1.6% vs 1%, p<0.001. In addition, they had higher rates for AKI, ARF, need for mechanical ventilation, length of stay and cost. No significant difference on risk for rhabdomyolysis. On multivariable analysis, patients with heart failure had higher odds for mortality adjusted odd’s ratio (a OR) 1.58 [95%CI: 1.15-2.17] p<0.01 and higher risk for stroke a OR 1.43 [95%CI:1.04-1.95] p=0.03. In addition, presence of heart failure significantly correlated with ARF, need for mechanical ventilation, higher cost and longer LOS. No significant association was demonstrated between heart failure and risk for Rhabdomyolysis, MI and AKI. Conclusion: Diabetic patients with heart failure who develop hyperosmolar hyperglycemic state are at higher risk for stroke and mortality and respiratory failure. Particular attention on fluid balance as well as early recognition for signs of stroke is warranted.

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The Evolving Role of Catheter Ablation in Patients With Heart Failure and AF

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2019.9.2 ◽

2019 ◽

Vol 8 (1) ◽

pp. 47-53

Author(s):

Sandeep Prabhu ◽

Wei H Lim ◽

Richard J Schilling

Keyword(s):

Heart Failure ◽

Clinical Practice ◽

Catheter Ablation ◽

Patient Group ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Evidence Base ◽

Patients With Heart Failure ◽

Recent Developments

AF and heart failure are emerging epidemics worldwide. Several recent trials have provided a growing evidence base for the benefits of catheter ablation in this patient group, which are yet to be universally adopted in clinical practice guidelines. This paper provides a summary of recent developments in this field and provides pragmatic advice to the treating physician regarding the appropriate role of catheter ablation in the overall management of patients with comorbid AF and heart failure.

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Recently Approved and Under Investigation Drugs for Treating Patients with Heart Failure

Current Cardiology Reviews ◽

10.2174/1573403x14666180702151626 ◽

2020 ◽

Vol 16 (3) ◽

pp. 202-211

Author(s):

Yaniel Castro-Torres ◽

Richard E. Katholi

Keyword(s):

Heart Failure ◽

Clinical Practice ◽

Mineralocorticoid Receptor ◽

Sodium Current ◽

Mineralocorticoid Receptor Antagonists ◽

Neuregulin 1 ◽

Reduced Ejection Fraction ◽

Vasoactive Peptides ◽

Patients With Heart Failure ◽

Erbb Signaling

: Heart Failure (HF) represents a leading cause of morbidity and mortality worldwide. Despite the recent advances in the treatment of this condition, patients´ prognosis remains unfavorable in most cases. Sacubitril/valsartan and ivabradine have been recently approved to improve clinical outcomes in patients with HF with reduced ejection fraction. Drugs under investigation for treating patients with HF encompass many novel mechanisms including vasoactive peptides, blocking inflammatory- mediators, natriuretic peptides, selective non-steroidal mineralocorticoid-receptor antagonists, myocardial β3 adrenoreceptor agonists, inhibiting the cytochrome C/cardiolipin peroxidase complex, neuregulin-1/ErbB signaling and inhibiting late inward sodium current. The aim of this manuscript is to review the main drugs under investigation for the treatment of patients with HF and give perspectives for their implementation into clinical practice.

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Assess frailty but avoid frailtyism

European Heart Journal Supplements ◽

10.1093/eurheartj/suz239 ◽

2019 ◽

Vol 21 (Supplement_L) ◽

pp. L17-L19

Author(s):

Cristiana Vitale ◽

Loreena Hill

Keyword(s):

Heart Failure ◽

Health Care ◽

Clinical Practice ◽

Care Plan ◽

Heart Failure Patients ◽

Frailty Assessment ◽

Limited Health ◽

Selection Of Patients ◽

Selection Of ◽

Made In

Abstract The assessment of frailty in heart failure patients can help clinicians to build a tailored care plan, aimed at improving the selection of patients likely to benefit from one treatment vs. another, thereby improving outcomes. Although progress has been made in the ‘operationalization’ of frailty assessment, there is still the need to provide an improved instrument to assess frailty that is easy, quick and at the same time predictive within the setting of a busy clinical practice. Using such an ideal instrument, clinicians would be able to optimize the use of limited health care resources and avoid what has been termed ‘frailtyism’. This term, similar to ageism, can be defined as prejudice or discrimination based on the presence of frailty.

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