scholarly journals The Management of Diabetic Patients with Heart Failure

2017 ◽  
Vol 10 ◽  
Author(s):  
Giuseppe Rosano ◽  
Petar Seferovic
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Therapeutic Agents ◽  
Diabetic Patients ◽  
Developing Heart ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
Patients With Diabetes ◽  
Reduction Of Mortality

Patients with diabetes mellitus have an increased risk of developing heart failure and diabetes mellitus is highly prevalent amongst patients with heart failure, especially those with HFpEF. Diabetic patients with heart failure have an increased mortality and an increased risk of hospitalisations and the use of certain anti- diabetic agents increase the risk of mortality and hospitalisation in heart failure. Conversely, newer therapeutic agents have shown a significant reduction of mortality, morbidity and risk of developing heart failure in diabetic patients with proven cardiovascular disease. This highly important area is reviewed in this paper.

scholarly journals Heart Failure in Patients with Diabetes Mellitus

2017 ◽  
Vol 03 (01) ◽  
pp. 52 ◽  
Author(s):  
Giuseppe MC Rosano ◽  
Cristiana Vitale ◽  
Petar Seferovic ◽  
◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Total Mortality ◽  
Glycated Haemoglobin ◽  
Diabetic Patients ◽  
Glucose Lowering ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
Patients With Diabetes ◽  
Negative Effect

Diabetes and heart failure are closely related: patients with diabetes have an increased risk of developing heart failure and those with heart failure are at higher risk of developing diabetes. Furthermore, antidiabetic medications increase the risk of mortality and hospitalisation for heart failure in patients with and without pre-existing heart failure. When the two diseases are considered individually, heart failure has a much poorer prognosis than diabetes mellitus; therefore heart failure has to be a priority for treatment in patients presenting with the two conditions, and the diabetic patient with heart failure should be managed by the heart failure team. No specific randomised clinical trials have been conducted to test the effect of cardiovascular drugs in diabetic patients with heart failure, but a wealth of evidence suggests that all interventions effective at improving prognosis in patients with heart failure are equally beneficial in patients with and without diabetes. The negative effect of glucose-lowering agents in patients with heart failure or at increased risk of heart failure has become evident after the withdrawal of rosiglitazone, a thiazolidinedione, from the EU market due to evidence of increased risk of cardiovascular events and hospitalisations for heart failure. An important issue that remains unresolved is the optimal target level of glycated haemoglobin, as recent studies have demonstrated significant reductions in total mortality, morbidity and risk of heart failure despite achieving HbA1c levels similar to those observed in the UKPDS study conducted some decades ago. Meta-analyses showed that intensive glucose lowering is not associated with any significant reduction in cardiovascular risk but conversely results in a significant increase in heart failure risk. Different medications have different risk: benefit ratios in diabetic patients with heart failure; therefore, the heart failure team must judge the required intensity of glycaemic control, the type and dose of glucose lowering agents and any change in glucose-lowering therapy, according to the clinical conditions present.

scholarly journals Proteomic mechanistic profile of patients with diabetes at risk of developing heart failure: insights from the HOMAGE trial

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Job A. J. Verdonschot ◽  
João Pedro Ferreira ◽  
Pierpaolo Pellicori ◽  
Hans-Peter Brunner-La Rocca ◽  
Andrew L. Clark ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Plasma Concentrations ◽  
Diabetic Patients ◽  
Proteomic Profile ◽  
Developing Heart ◽  
Diabetes Status ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Patients At Risk

Abstract Background Patients with diabetes mellitus (DM) are at increased risk of developing heart failure (HF). The “Heart OMics in AGEing” (HOMAGE) trial suggested that spironolactone had beneficial effect on fibrosis and cardiac remodelling in an at risk population, potentially slowing the progression towards HF. We compared the proteomic profile of patients with and without diabetes among patients at risk for HF in the HOMAGE trial. Methods Protein biomarkers (n = 276) from the Olink®Proseek-Multiplex cardiovascular and inflammation panels were measured in plasma collected at baseline and 9 months (or last visit) from HOMAGE trial participants including 217 patients with, and 310 without, diabetes. Results Twenty-one biomarkers were increased and five decreased in patients with diabetes compared to non-diabetics at baseline. The markers clustered mainly within inflammatory and proteolytic pathways, with granulin as the key-hub, as revealed by knowledge-induced network and subsequent gene enrichment analysis. Treatment with spironolactone in diabetic patients did not lead to large changes in biomarkers. The effects of spironolactone on NTproBNP, fibrosis biomarkers and echocardiographic measures of diastolic function were similar in patients with and without diabetes (all interaction analyses p > 0.05). Conclusions Amongst patients at risk for HF, those with diabetes have higher plasma concentrations of proteins involved in inflammation and proteolysis. Diabetes does not influence the effects of spironolactone on the proteomic profile, and spironolactone produced anti-fibrotic, anti-remodelling, blood pressure and natriuretic peptide lowering effects regardless of diabetes status.  Trial registration NCT02556450.

scholarly journals The Bi-directional Impact of Two Chronic Illnesses: Heart Failure and Diabetes – A review of the Epidemiology and Outcomes

2015 ◽  
Vol 1 (1) ◽  
pp. 8 ◽  
Author(s):  
Patrick Campbell ◽  
Selim Krim ◽  
Hector Ventura ◽  
◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Hospital Admissions ◽  
Chronic Illnesses ◽  
Morbidity And Mortality ◽  
Developing Heart ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
The Us ◽  
Failure Experience

Heart failure and diabetes mellitus contribute significantly to the morbidity and mortality of the US population. The combined economic impact on the US health care system reaches nearly $300 billion. Much of this cost stems from the frequent hospital admissions and direct cost of managing the two diseases. The presence of diabetes significantly increases the risk of developing heart failure compared to the general population and diabetics with heart failure experience significantly higher mortality. Patients with heart failure have a high incidence of insulin resistance and are at increased risk of developing diabetes mellitus. Traditionally these two chronic illnesses have been managed in relative isolation. However the adverse effects of each disease has significant impact on the other. The combination of heart failure and diabetes mellitus significantly increases the morbidity and mortality compared to either in isolation. This paper reviews the epidemiology and impact of the bidirectional effects of these two chronic illnesses.

Cardiac Outcomes After Myocardial Infarction in Elderly Patients With Diabetes Mellitus

2002 ◽  
Vol 11 (6) ◽  
pp. 504-519 ◽  
Author(s):  
Deborah Chyun ◽  
Viola Vaccarino ◽  
Jaime Murillo ◽  
Lawrence H. Young ◽  
Harlan M. Krumholz
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Elderly Patients ◽  
Ventricular Function ◽  
Clinical Findings ◽  
Comorbid Conditions ◽  
Recurrent Myocardial Infarction ◽  
Increased Risk ◽  
Patients With Diabetes

• Objective To examine the association between (1) comorbid conditions related to diabetes mellitus, clinical findings on arrival at the hospital, and characteristics of the myocardial infarction and (2) risk of heart failure, recurrent myocardial infarction, and mortality in the year after myocardial infarction in elderly 30-day survivors of myocardial infarction who had non–insulin- or insulin-treated diabetes. • Methods Medical records for June 1, 1992, through February 28, 1993, of Medicare beneficiaries (n = 1698), 65 years or older, hospitalized for acute myocardial infarction in Connecticut were reviewed by trained abstractors. • Results One year after myocardial infarction, elderly patients with non–insulin- and insulin-treated diabetes mellitus had significantly greater risk for readmission for heart failure and recurrent myocardial infarction than did patients without diabetes mellitus, and risk was greater in patients treated with insulin than in patients not treated with insulin. Diabetes mellitus, comorbid conditions related to diabetes mellitus, clinical findings on arrival, and characteristics of the myocardial infarction, specifically measures of ventricular function, were important predictors of these outcomes. Mortality was greater in patients not treated with insulin than in patients treated with insulin; the increased risk was mostly due to comorbid conditions related to diabetes mellitus and poorer ventricular function. • Conclusions Risk of heart failure, recurrent myocardial infarction, and mortality is elevated in elderly patients who have non–insulin- or insulin-treated diabetes mellitus. Comorbid conditions related to diabetes mellitus and ventricular function at the time of the index myocardial infarction are important contributors to poorer outcomes in patients with diabetes mellitus.

scholarly journals In Hospital Frequency of Heart Failure in STEMI after Thrombolysis in Patient with Diabetes

2021 ◽  
pp. 66-71
Author(s):  
Abdul Mueed ◽  
Nandlal Rathi ◽  
Shazia Kazi ◽  
Raj Kumar Sachdewani ◽  
. Shahzad ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Heart Disease ◽  
Previous History ◽  
P Value ◽  
Diabetic Patients ◽  
Chi Square ◽  
St Segment Elevation ◽  
Patients With Diabetes ◽  
End Stage

Objective: To determine the frequency of heart failure after thrombolysis in STEMI patients with diabetes mellitus. Methodology: Through a prospective study we have enrolled all the diabetic patients who presented with acute ST-Segment Elevation Myocardial Infarction (STEMI) having age more than 35 years and less than 70 years who underwent pharmacological revascularization both males and females were included in this study. Patients with previous history of revascularization, end stage kidney, liver or heart disease, known advanced valvular heart disease, pregnant women, and those who develop serious complication related to streptokinase were excluded from our study. Echocardiography was done immediately after thrombolysis then after 3 days and then before discharge of the patients to determine the frequency of heart failure. Baseline and clinical data were entered and analysed using SPSS and a chi square test and p-value ≤0.05 was considered as significant. Results: A total of 175 patients were finally analysed and most of them were males as compared to females, 63.42% (N = 111) vs. 36.57% (N = 64), respectively. Mean age and SD of the patients was 55.90±10.49 years and mean duration of DM was 12.95±8.40 years. The overall frequency of heart failure in patients with post-STEMI was 56% (N = 98) and their mean ejection fraction was 38.46±8.20%. Frequency of heart failure in diabetic post-STEMI thrombolysed patients was significantly observed higher with increased age, increased duration of diabetes mellitus, hypertension, and smoking (p≤0.05). Conclusion: High prevalence of heart failure was observed in diabetic patients admitted with acute STEMI and underwent thrombolysis. The burden is even higher in males having age more than 55 years.

Diabetes und Herzinsuffizienz

2019 ◽  
Vol 14 (03) ◽  
pp. 180-192
Author(s):  
Philipp H. Baldia ◽  
Nikolaus Marx ◽  
Katharina A. Schütt
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Early Stage ◽  
Hospitalization Rates ◽  
Patients With Heart Failure ◽  
Patients With Diabetes ◽  
Treatment Of Diabetes ◽  
The Common ◽  
Current Guidelines ◽  
Positive Effect

AbstractDiabetes mellitus is a very important comorbidity in patients with heart failure, as the common presence of both diseases significantly worsens the prognosis of patients. In order to improve the outcome of these patients, it is essential to diagnose both diseases at an early stage and to treat them in accordance with guidelines. In particular, a differentiated medication plays a crucial role. The therapy of heart failure does not differ in patients with diabetes and patients without diabetes. In the treatment of diabetes mellitus, however, it is very important to choose substances that have a positive effect on the cardiovascular outcome of patients. First-line treatment of diabetes in patients with cardiovascular diseases should be metformin, followed by a SGLT-2 inhibitor or GLP-1 receptor agonist with proven cardiac benefit. A rigorous adjustment of risk factors according to current guidelines reduces cardiovascular mortality and hospitalization rates. Glitazones and saxagliptin are associated with increased hospitalization rates and should be avoided in heart failure.

Heart failure in patients with diabetes in Campania

2019 ◽  
Vol 22 (4) ◽  
pp. 219
Author(s):  
Botta, A.
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Symptoms ◽  
Healthcare Services ◽  
Key Words Diabetes Mellitus ◽  
Diabetic Patients ◽  
Key Words Diabetes ◽  
Antidiabetic Therapy ◽  
Patients With Diabetes

Heart Failure (HF) and Type 2 Diabetes Mellitus (T2D) are important clinical conditions that often coexist, mutually influencing intra- and extra-hospital morbidity and mortality. In order to characterize the diagnostic and therapeutic management of patients with HF and T2D, a retrospective observational study was conducted on database of the last 12 months in 8 Campania Diabetology Centers. 164 patients were affected by HF and T2D. Among them, 123 patients had a medical record with reproducible data and were recruited for the study. Diabetic patients were divided into three groups: group A included patients with preserved ejection fraction (EF) (> 50 %), group B patients with midrange EF (40-49%) and the group C patients with reduced EF (< 40%). All patients had performed ECG and echocardiography, repeated every 6 months; 41 patients (33% of the sample) also performed a cardiac Holter. The most frequent causes of HF were ischemic heart disease and hypertension. After a 12 months follow up, the clinical and laboratory parameters and the treatments adopted were re-evaluated. The antidiabetic drugs resulted modified with a reduction in the use of metformin, sulfonylureas, glinids and pioglitazone; at the same time a greater use of gliptins, gliflozines and GLP1 AR and a lower use of insulin therapy was observed. Cardiological therapy was modified with a greater use of diuretics and nitrates and a reduction of ACEI and ARB, probably due to the use of sacubitril/valsartan association in the group of patients with reduced EF. According to the recent guidelines, antidiabetic therapy must be tailored to the characteristics of the patients with diabetes and heart failure, preferring the use of molecules that have shown a cardiovascular protection effect or, secondarily, those with cardiovascular neutrality. Similarly, cardiological therapies have to consider the type of antidiabetic agents used and benefit from molecules that impact clinical symptoms and natural history. Finally, the approach to the patients with both the pathologies must necessarily take place in the healthcare districts and absolutely be multidisciplinary and integrated, involving firstly Diabetologists and Cardiologists, but also other professional roles (nurses, psychologists, physiotherapists, caregivers) operating in the territorial healthcare services. KEY WORDS diabetes mellitus; heart failure; ejection fraction.

P777Changes in glycated hemoglobin in patients with heart failure with reduced ejection fraction treated with sacubitril/valsartan

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Stassinos ◽  
S Bezati ◽  
D Leftheriotis ◽  
C Kardamis ◽  
P Dourvas ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Repeated Measures ◽  
Glycated Hemoglobin ◽  
Relative Reduction ◽  
Diabetic Patients ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Hba1c Levels

Abstract Introduction Glycemic control reflected by glycated hemoglobin (HbA1c) is regarded as a risk factor and a strong predictor of mortality in patients with heart failure (HF). Hyperglycemia may contribute to oxidative stress, endotelial dysfunction and cardiac fibrosis and influence negatively heart failure prognosis in patients with or without diabetes. Treatment with neprilysin inhibitors in combination with angiotensin II receptor antagonist,(ARNIs) has shown beneficial effects in morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF). Purpose We sought to investigate eventual reductions in HbA1c in patients receiving the novel therapy. Methods We enrolled a total of 52 stable patients with HFrEF eligible for treatment with ARNIs. Patients were administered a target dose of 200mg bid (97mg sacubitril/103mg valsartan) and we measured HbA1c before, 3months and 6months after initiation of therapy. Changes in HbA1c levels were tested with General Linear Model Repeated Measures test. Spearmans' Rho correlation analysis was performed to investigate possible relationship between the above. Results Mean age was 62±10 years, 69,2% of patients were on New York Heart Association (NYHA) functional class II, 23,1% on NYHA III and 7,7% on NYHA IV. 57,7% had ischemic while 42,3% dilated cardiomyopathy, 25% chronic kidney disease and 38,5% diabetes mellitus. Mean Body Mass Index (BMI) was 29,88±4,66 kg/m2. Median value of baseline HbA1c was 5,8% (IQR 0,9). Compared to baseline values, HbA1c decreased to 5,6 (IQR 0,9) and 5,7 (IQR 0,83) (p=0,012) at three and six months of treatment, respectively. Change in HbA1c levels was associated significantly with the presence of diabetes mellitus (p=0,013) and diabetic patients showed greater relative reduction in HbA1c (8%) compared to non diabetic patients (1%). Spearmans' Rho test revealed statistically significant association between changes in HbA1c levels from initiation to three months of therapy, while changes between initiation to six months of administration did non correlate with the presence of diabetes. Changes in HbA1c Conclusions HbA1c levels were reduced significantly during treatment with sacubitril/valsartan. Changes were independent of diabetes in six months of treatment.

scholarly journals Application of artificial intelligence in prediction of cardiovascular complications in patients with diabetes mellitus type 2: A protocol of systematic review

2021 ◽  
Author(s):  
Hengameh Ferdosian ◽  
◽  
Hadi Zamanian ◽  
Sayed Ali Emami ◽  
Elahe Sedighi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Microvascular Complications ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Review Question

Review question / Objective: The aim of this systematic review is to evaluate AI-based models in identifying predictors of cardiovascular events and risk predtion in patients with diabetes mellitus type2. Condition being studied: T2DM patients have an increased risk of macrovascular and microvascular complications, lead to decreased quality of life and mortality. Considering the significance of cardiovascular complications in these patients, prediction of such events would be important. Different traditional statistical methods(such as regression) and new AI-besed algorithms are used to predict these complications in diabetic patients.

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