Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction

Paolillo, Stefania; Salvioni, Elisabetta; Filardi, Pasquale Perrone; Bonomi, Alice; Sinagra, Gianfranco; Gentile, Piero; Gargiulo, Paola; Scoccia, Alessandra; Cosentino, Nicola; Gugliandolo, Paola; Badagliacca, Roberto; Lagioia, Rocco; Correale, Michele; Frigerio, Maria; Perna, Enrico; Piepoli, Massimo F; Re, Federica; Raimondo, Rosa; Minà, Chiara; Clemenza, Francesco; Bussotti, Maurizio; Limongelli, Giuseppe; Gravino, Rita; Passantino, Andrea; Magrì, Damiano; Parati, Gianfranco; Caravita, Sergio; Scardovi, Angela Beatrice; Arcari, Luca; Vignati, Carlo; Mapelli, Massimo; Cattadori, Gaia; Cavaliere, Carlo; Corrà, Ugo; Agostoni, Piergiuseppe

doi:10.1016/j.ijcard.2020.04.079

Cited by 16 publications

(15 citation statements)

References 28 publications

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“…25 In the REACH Registry, 26 diabetes was associated with a 33% greater risk of hospitalization for heart failure and the presence of heart failure at baseline was independently associated with cardiovascular death and hospitalization for heart failure. However, in a recent analysis of the MECKI score database 27 performed in 3927 HFrEF patients, a worse prognosis was observed in patients with poor glycaemic control (HbA1c >8%) (Figure 1), whereas the presence of a diabetic status and ongoing anti-diabetic treatment were not related to prognosis after correction for multiple confounders. 8 Left ventricular (LV) dysfunction in patients with type 2 diabetes may present as HFpEF, HFrEF or heart failure with mid-range ejection fraction.…”

Section: Diabetesmentioning

confidence: 96%

Role of comorbidities in heart failure prognosis Part I: Anaemia, iron deficiency, diabetes, atrial fibrillation

Paolillo¹,

Scardovi

Campodonico

2020

European Journal of Preventive Cardiology

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Cardiovascular and non-cardiovascular comorbidities are frequently observed in heart failure patients, complicating the therapeutic management and leading to poor prognosis. The prompt recognition of associated comorbid conditions is of great importance to optimize the clinical management, the follow-up, and the treatment of patients affected by chronic heart failure. Anaemia and iron deficiency are commonly reported in all heart failure forms, have a multifactorial aetiology and are responsible for reduced exercise tolerance, impaired quality of life, and poor long-term prognosis. Diabetes mellitus is highly prevalent in heart failure and a poor glycaemic control is associated with worst outcome. Two specific heart failure forms are usually observed in diabetic patients: an ischaemic cardiomyopathy or a typical diabetic cardiomyopathy. The implementation of use of sodium-glucose cotransporter-2 inhibitors will much improve in the near future the long-term prognosis of patients affected by heart failure and diabetes. Among cardiovascular comorbidities, atrial fibrillation is the most common arrhythmic disease of heart failure patients and it is still not clear whether its presence should be considered as a prognostic indicator or as a marker of advanced disease. The aim of the present review was to explore the clinical and prognostic impact of anaemia and iron deficiency, diabetes mellitus, and atrial fibrillation in patients affected by chronic heart failure.

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Section: Diabetesmentioning

confidence: 96%

Role of comorbidities in heart failure prognosis Part I: Anaemia, iron deficiency, diabetes, atrial fibrillation

Paolillo¹,

Scardovi

Campodonico

2020

European Journal of Preventive Cardiology

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“…Patients with DM may develop asymptomatic myocardial dysfunction or overt HF status more frequently than in the general population that is not necessarily related to coronary atherosclerosis, and HF complicates the management and progression of DM over time. In particular, glycemic control over time seems to be the main predictor of prognosis in these patients [26,27]. In the last years, some concerns have been raised regarding the use of β-blockers in patients with DM due to a possible role of these drugs in masking hypoglycemic signs, such as tachycardia, and to a possible direct hypoglycemic effect of β-blockers.…”

Section: β-Blockers and Diabetes Mellitusmentioning

confidence: 99%

The use of β-blockers in patients with heart failure and comorbidities: Doubts, certainties and unsolved issues

Paolillo

Dell’Aversana²,

Esposito³

et al. 2021

European Journal of Internal Medicine

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β-blockers represent a mainstay in the pharmacological approach to patients affected by heart failure with reduced ejection fraction (HFrEF). However, underuse of this class of drugs is still reported, especially in the presence of cardiovascular and non-cardiovascular comorbidities, even if they are not contraindications for prescription of a β-blocker. The prognostic benefit of β-blockers is relevant in the presence of comorbidities, and achievement of the maximum tolerated dose is an important goal to increase their favorable prognostic role. The aim of the present review is to analyze the available evidence on the use of β-blockers in HFrEF patients with the most common comorbidities. In particular, we will discuss the role and most appropriate beta-blocker in patients with pulmonary disease (bisoprolol, metoprolol, nebivolol), diabetes (carvedilol and nebivolol), atrial fibrillation (all indicated for rate control, with metoprolol as the first choice followed by bisoprolol, nebivolol, and carvedilol), erectile dysfunction (bisoprolol and nebivolol), peripheral arterial disease (nebivolol), and other conditions, in order to clarify the correct use of this class of drugs in the clinical practice.

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“…Candesartan Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) study showed a linear relationship between HbA1c and risk of all-cause mortality as well as HF hospitalization [24]. An analysis of the Metabolic Exercise Cardiac Kidney Index (MECKI) score database revealed a worse prognosis in HFrEF patients with HbA1c > 8% after adjustment for confounding factors [25]. In contrast, more contemporary data on cohort of HF populations pointed to a U-shaped relationship between HbA1c control level and HF prognosis.…”

Section: Discussionmentioning

confidence: 99%

HbA1c Level is Associated with Heart Failure with Recovered Ejection Fraction in Type 2 Diabetic Patients

Yang

Aihemaiti

Quan

et al. 2022

Preprint

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Background: Due to advances in medical treatments, a substantial proportion of heart failure (HF) patients with reduced left ventricular ejection fraction (EF, HFrEF) have experienced partial or complete recovery of EF, termed HFrecEF, and markedly improved clinical outcomes. In the present study, we sought to investigate the relationship between glycemic control and the incidence of HFrecEF in patients with type 2 diabetes mellitus (T2DM).Methods: A total of 385 T2DM patients with HFrEF were consecutively enrolled. Follow-up echocardiogram was performed after 6 to 12 months, which classified patients into HFrecEF or persistent HFrEF. Clinical outcomes of cardiovascular (CV) death and HF rehospitalization were analyzed during a mean of 3.3 years follow-up. Results: T2DM patients with HFrecEF had significantly lower HbA1c level than those with persistent HFrEF (6.4% [IQR 5.8%~7.1%] vs. 6.8% [IQR 6.1%~7.8%], P=0.001), especially in HF of ischemic etiology. After multivariate adjustment, every 1% increase in HbA1c conferred a 21.3% (OR: 0.787 [95% CI 0.658~0.933]) lower likelihood of HFrecEF. Compared to patients with good glycemic control (HbA1c≤6%), those with poor glycemic control (HbA1c > 8%) had higher risk of CV death or HF rehospitalization (HR: 2.778 [95% CI 1.470~5.251]). T2DM Patients with HFrecEF exhibited significantly better clinical outcomes than those with persistent HFrEF.Conclusions: This study demonstrates that T2DM patients with uncontrolled HbA1c levels were associated with compromised development of HFrecEF and worse clinical outcomes.

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Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction

Cited by 16 publications

References 28 publications

Role of comorbidities in heart failure prognosis Part I: Anaemia, iron deficiency, diabetes, atrial fibrillation

Role of comorbidities in heart failure prognosis Part I: Anaemia, iron deficiency, diabetes, atrial fibrillation

The use of β-blockers in patients with heart failure and comorbidities: Doubts, certainties and unsolved issues

HbA1c Level is Associated with Heart Failure with Recovered Ejection Fraction in Type 2 Diabetic Patients

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