A review of current key guidelines for managing high risk patients with diabetes and heart failure and future prospects

Lee, M. M.Y. and Sattar, N. (2023) A review of current key guidelines for managing high risk patients with diabetes and heart failure and future prospects. Diabetes, Obesity and Metabolism, 25(S3), pp. 33-47. (doi: 10.1111/dom.15085) (PMID:37041663)

Abstract

Aims: To review recent guidelines on management of heart failure (HF) in patients with diabetes. Materials and methods: Major recommendations in European and USA society guidelines were scrutinised. Results: First, sodium-glucose co-transporter 2 inhibitors (SGLT2i) are now recommended treatments for all patients with symptomatic heart failure (stage C and D; New York Heart Association II-IV), irrespective of diabetes status and left ventricular ejection fraction (LVEF). Second, patients with HF and reduced ejection fraction (LVEF ≤40%) should have foundational therapies from four drug classes (SGLT2i, angiotensin-receptor neprilysin inhibitor (ARNI), beta-blocker and mineralocorticoid receptor antagonist (MRA)). Third, patients with HF with mildly reduced (41-49%) and preserved (≥50%) LVEF may also benefit from ARNI, beta-blocker and MRA therapy, although evidence for these is less robust. Fourth, selected patients should be considered for other therapies such as diuretics (if congestion), anticoagulation (if atrial fibrillation) and cardiac device therapy. Fifth, glucose-lowering therapies such as thiazolidinediones and certain dipeptidyl peptidase-4 inhibitors (such as saxagliptin and alogliptin) should be avoided in patients with heart failure. Sixth, guidelines recommend enrolment of patients with HF into exercise rehabilitation and multidisciplinary HF management programmes. Particular attention should be paid to important co-morbidities such as obesity, alongside pharmacological therapies. Conclusions: As diabetes and obesity are major risk factors for HF, earlier consideration of, and diagnosis of HF, followed by guideline-directed medical therapy can meaningfully improve patients’ lives. Diabetes doctors would do well to understand the basics of such guidelines to help improve all aspects of HF diagnosis and care.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lee, Matthew and Sattar, Professor Naveed
• Authors: Lee, M. M.Y., and Sattar, N.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Diabetes, Obesity and Metabolism
• Publisher: Wiley
• ISSN: 1462-8902
• ISSN (Online): 1463-1326
• Published Online: 11 April 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Diabetes, Obesity and Metabolism 25(S3):33-47
• Publisher Policy: Reproduced under a Creative Commons License