Suzanne V Arnold1, Jonathan Yap2, Carolyn S P Lam2,3,4, Fengming Tang1, Wan T Tay2, Tiew H K Teng2, Darren K McGuire5, James L Januzzi6, Gregg C Fonarow7, Frederick A Masoudi8, Mikhail Kosiborod1. 1. Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri. 2. National Heart Centre Singapore, Singapore. 3. Duke-NUS Medical School, Singapore. 4. Department of Cardiology, University Medical Centre Groningen, Groningen, the Netherlands. 5. University of Texas Southwestern Medical Center, Dallas, Texas. 6. Massachusetts General Hospital, Boston, Massachusetts. 7. University of California, Los Angeles, California, Los Angeles. 8. University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Abstract
AIMS: To compare the management of patients with diabetes and heart failure with reduced ejection fraction (HFrEF) in the United States and Asia to understand variations in treatment patterns across different healthcare systems. MATERIALS AND METHODS: Our cohort included patients with diabetes and HFrEF (ejection fraction <40%) from a US-based registry of adults with diabetes (2013-2016, electronic health records) and a multi-national Asian registry of adults with heart failure (2010-2016, prospective registry). Asian countries were categorized as high income (HI) or low income (LI), according to the United Nations classification. Rates of use of guideline-directed medical therapies (determined through review of active medication lists) were compared across regions. RESULTS: Patients with diabetes and HFrEF in the United States (n = 28 877) were older, had higher body mass indices, and were more likely to have coronary disease than those in Asia (n = 2235). Compared with US patients, the use of guideline-directed medical therapy for HFrEF was lower in patients in LI Asian countries (angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers: patients in the United States, 77% vs. patients in HI Asian countries, 76% vs patients in LI Asian countries, 69%; β-blockers: patients in the United States, 91% vs. patients in HI Asian countries, 87% vs. patients in LI Asian countries, 69%; P < 0.001 for both). Insulin was used more commonly in the United States (44% vs. 24% vs. 25%, respectively; P < 0.001), whereas sulphonylureas were more often prescribed in Asian countries (42% vs. 52% vs. 54%; respectively, P < 0.001). Thiazolidinediones were prescribed in 6% of US patients compared with <1% of patients in Asia. The use of newer diabetes medications was <5% in all. CONCLUSION: In both the United States and Asia, opportunities for improvement in the use of evidence-based therapies exist for patients with both diabetes and HFrEF. Effective tools to guide medication choices for these complex, high-risk patients could have substantial impact on quality and outcomes.
AIMS: To compare the management of patients with diabetes and heart failure with reduced ejection fraction (HFrEF) in the United States and Asia to understand variations in treatment patterns across different healthcare systems. MATERIALS AND METHODS: Our cohort included patients with diabetes and HFrEF (ejection fraction <40%) from a US-based registry of adults with diabetes (2013-2016, electronic health records) and a multi-national Asian registry of adults with heart failure (2010-2016, prospective registry). Asian countries were categorized as high income (HI) or low income (LI), according to the United Nations classification. Rates of use of guideline-directed medical therapies (determined through review of active medication lists) were compared across regions. RESULTS:Patients with diabetes and HFrEF in the United States (n = 28 877) were older, had higher body mass indices, and were more likely to have coronary disease than those in Asia (n = 2235). Compared with US patients, the use of guideline-directed medical therapy for HFrEF was lower in patients in LI Asian countries (angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers: patients in the United States, 77% vs. patients in HI Asian countries, 76% vs patients in LI Asian countries, 69%; β-blockers: patients in the United States, 91% vs. patients in HI Asian countries, 87% vs. patients in LI Asian countries, 69%; P < 0.001 for both). Insulin was used more commonly in the United States (44% vs. 24% vs. 25%, respectively; P < 0.001), whereas sulphonylureas were more often prescribed in Asian countries (42% vs. 52% vs. 54%; respectively, P < 0.001). Thiazolidinediones were prescribed in 6% of US patients compared with <1% of patients in Asia. The use of newer diabetes medications was <5% in all. CONCLUSION: In both the United States and Asia, opportunities for improvement in the use of evidence-based therapies exist for patients with both diabetes and HFrEF. Effective tools to guide medication choices for these complex, high-risk patients could have substantial impact on quality and outcomes.
Authors: Mohamad Khattab; Purvi Parwani; Mubasher Abbas; Huzair Ali; Pedro M Lozano; Udho Thadani; Tarun W Dasari Journal: J Family Med Prim Care Date: 2020-06-30
Authors: Suzanne V Arnold; Philip G Jones; Michael Beasley; Jeanine Cordova; Abhinav Goyal; Gregg C Fonarow; Leo Seman Journal: Cardiovasc Diabetol Date: 2020-12-12 Impact factor: 9.951
Authors: Alice M Jackson; Rasmus Rørth; Jiankang Liu; Søren Lund Kristensen; Inder S Anand; Brian L Claggett; John G F Cleland; Vijay K Chopra; Akshay S Desai; Junbo Ge; Jianjian Gong; Carolyn S P Lam; Martin P Lefkowitz; Aldo P Maggioni; Felipe Martinez; Milton Packer; Marc A Pfeffer; Burkert Pieske; Margaret M Redfield; Adel R Rizkala; Jean L Rouleau; Petar M Seferović; Jasper Tromp; Dirk J Van Veldhuisen; Mehmet B Yilmaz; Faiez Zannad; Michael R Zile; Lars Køber; Mark C Petrie; Pardeep S Jhund; Scott D Solomon; John J V McMurray Journal: Eur J Heart Fail Date: 2022-01-04 Impact factor: 17.349