Muthiah Vaduganathan1, Gregg C Fonarow2, Stephen J Greene3, Adam D DeVore4, Abhishek Kavati5, Slaven Sikirica5, Nancy M Albert6, Carol I Duffy5, C Larry Hill7, J Herbert Patterson8, John A Spertus9, Laine E Thomas10, Fredonia B Williams11, Adrian F Hernandez7, Javed Butler12. 1. Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts. Electronic address: https://twitter.com/@mvaduganathan. 2. Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, California. Electronic address: https://twitter.com/@gcfmd. 3. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. Electronic address: https://twitter.com/@SJGreene_md. 4. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. Electronic address: https://twitter.com/@_adevore. 5. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey. 6. Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio. 7. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. 8. Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina. 9. Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: https://twitter.com/@jspertus. 10. Duke Clinical Research Institute and Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina. Electronic address: https://twitter.com/@texhern. 11. Mended Hearts, Huntsville, Alabama. 12. Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi. Electronic address: jbutler4@umc.edu.
Abstract
OBJECTIVES: The purpose of this study was to characterize the clinical profile, treatment patterns, and clinical outcomes of patients with comorbid diabetes mellitus (DM) and heart failure with reduced ejection fraction (HFrEF) in a contemporary, real-world U.S. outpatient registry in the context of evolving treatment strategies. BACKGROUND: Specific antihyperglycemic classes have differential risks and benefits with respect to HF. Limited data are available evaluating contemporary treatment patterns and outcomes of patients with comorbid DM and HFrEF. METHODS: Among 4,970 patients with chronic HFrEF (≤40%) across 152 U.S. sites in the CHAMP-HF prospective, observational registry (2015 to 2017), we examined therapies and clinical outcomes by DM status. RESULTS: Median age was 68 (58 to 75) years of age; 29% were women; 73.5% were white; and 64% had coronary artery disease. Overall, 42% (n = 2,085) had comorbid DM with a median hemoglobin A1c (HbA1c) level of 7.2% (interquartile range [IQR]: 6.4% to 8.3%). One-fourth of DM patients (24%) were not treated with an antihyperglycemic therapy. Most patients with DM were taking 1 (46%) or 2 (23%) antihyperglycemic therapies: metformin (40%); insulin (33%); sulfonylureas (24%); dipeptidyl peptidase-4 inhibitors (10%); glucagon-like peptide (GLP)-1 receptor agonists (4%); sodium-glucose cotransporter (SGLT)-2 inhibitors (2%); and thiazolidinediones (2%). Among patients with DM, 62%, 16%, 80%, and 33.5% were receiving any angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitor (ARNI), β-blockers, or mineralocorticoid receptor antagonists (MRAs) at baseline, respectively. Among patients without DM, corresponding baseline rates were 65%, 15%, 80%, and 37%, respectively. Patients with or without DM were infrequently treated with guideline-directed HFrEF therapies at target doses (≤27% across classes). During median 15-month follow-up, patients with DM experienced higher rates of all-cause mortality or HF hospitalization (30% vs. 23%, respectively), independent of 11 pre-specified covariates (adjusted hazard ratio: 1.35 (95% confidence interval: 1.21 to 1.52); p < 0.001). CONCLUSIONS: Despite higher risk-adjusted clinical event rates in patients with comorbid HFrEF and DM, guideline-directed medical therapies for both disease states are incomplete and represent an important target for quality improvement through multidisciplinary care pathways.
OBJECTIVES: The purpose of this study was to characterize the clinical profile, treatment patterns, and clinical outcomes of patients with comorbid diabetes mellitus (DM) and heart failure with reduced ejection fraction (HFrEF) in a contemporary, real-world U.S. outpatient registry in the context of evolving treatment strategies. BACKGROUND: Specific antihyperglycemic classes have differential risks and benefits with respect to HF. Limited data are available evaluating contemporary treatment patterns and outcomes of patients with comorbid DM and HFrEF. METHODS: Among 4,970 patients with chronic HFrEF (≤40%) across 152 U.S. sites in the CHAMP-HF prospective, observational registry (2015 to 2017), we examined therapies and clinical outcomes by DM status. RESULTS: Median age was 68 (58 to 75) years of age; 29% were women; 73.5% were white; and 64% had coronary artery disease. Overall, 42% (n = 2,085) had comorbid DM with a median hemoglobin A1c (HbA1c) level of 7.2% (interquartile range [IQR]: 6.4% to 8.3%). One-fourth of DMpatients (24%) were not treated with an antihyperglycemic therapy. Most patients with DM were taking 1 (46%) or 2 (23%) antihyperglycemic therapies: metformin (40%); insulin (33%); sulfonylureas (24%); dipeptidyl peptidase-4 inhibitors (10%); glucagon-like peptide (GLP)-1 receptor agonists (4%); sodium-glucose cotransporter (SGLT)-2 inhibitors (2%); and thiazolidinediones (2%). Among patients with DM, 62%, 16%, 80%, and 33.5% were receiving any angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitor (ARNI), β-blockers, or mineralocorticoid receptor antagonists (MRAs) at baseline, respectively. Among patients without DM, corresponding baseline rates were 65%, 15%, 80%, and 37%, respectively. Patients with or without DM were infrequently treated with guideline-directed HFrEF therapies at target doses (≤27% across classes). During median 15-month follow-up, patients with DM experienced higher rates of all-cause mortality or HF hospitalization (30% vs. 23%, respectively), independent of 11 pre-specified covariates (adjusted hazard ratio: 1.35 (95% confidence interval: 1.21 to 1.52); p < 0.001). CONCLUSIONS: Despite higher risk-adjusted clinical event rates in patients with comorbid HFrEF and DM, guideline-directed medical therapies for both disease states are incomplete and represent an important target for quality improvement through multidisciplinary care pathways.
Authors: Andy T Tran; Gregg C Fonarow; Suzanne V Arnold; Philip G Jones; Laine E Thomas; C Larry Hill; Adam D DeVore; Javed Butler; Nancy M Albert; John A Spertus Journal: Circ Cardiovasc Qual Outcomes Date: 2021-10-07
Authors: Muthiah Vaduganathan; Stephen J Greene; Shuaiqi Zhang; Maria Grau-Sepulveda; Adam D DeVore; Javed Butler; Paul A Heidenreich; Joanna C Huang; Michelle M Kittleson; Karen E Joynt Maddox; James J McDermott; Anjali Tiku Owens; Pamela N Peterson; Scott D Solomon; Orly Vardeny; Clyde W Yancy; Gregg C Fonarow Journal: JAMA Cardiol Date: 2020-11-13 Impact factor: 14.676
Authors: Rishav Adhikari; Kunal Jha; Zeina Dardari; James Heyward; Roger S Blumenthal; Robert H Eckel; G Caleb Alexander; Michael J Blaha Journal: J Am Heart Assoc Date: 2022-04-27 Impact factor: 6.106
Authors: John A Spertus; Mary C Birmingham; Javed Butler; Ildiko Lingvay; David E Lanfear; Antonio Abbate; Mikhail L Kosiborod; Christina Fawcett; Paul Burton; C V Damaraju; James L Januzzi; John Whang Journal: Circ Heart Fail Date: 2021-03-16 Impact factor: 8.790
Authors: Adam D DeVore; Bradi B Granger; Gregg C Fonarow; Hussein R Al-Khalidi; Nancy M Albert; Eldrin F Lewis; Javed Butler; Ileana L Piña; Larry A Allen; Clyde W Yancy; Lauren B Cooper; G Michael Felker; Lisa A Kaltenbach; A Thomas McRae; David E Lanfear; Robert W Harrison; Maghee Disch; Dan Ariely; Julie M Miller; Christopher B Granger; Adrian F Hernandez Journal: JAMA Date: 2021-07-27 Impact factor: 56.272