Management of patients with chronic heart failure and diabetes mellitus from the standpoint of modern recommendations and in real clinical practice

Aim. Our aim was to assess the accordance of treatment of patients with chronic heart failure and diabetes mellitus (CHF+DM) in real clinical practice with current guidelines and its association with prognosis. Materials and methods. We analyzed 2144 cases of patients admitted to а hospital due to decompensation of CHF in the period from 2014-2018. 207 (9.7%) of these patients had CHF with a left ventricular ejection fraction of <45% and type 2 diabetes [median of age was 69 (interquartile range of 62; 77) years]. The analysis of recommended medications at discharge and survival was performed. Results. Аngiotensin-converting enzyme inhibitors were prescribed to 132 (63.7%) patients: enalapril - 61 (29.4%), perindopril - 42 (20.3%), fosinopril - 29 (14.0%). The angiotensin II receptor antagonist losartan was prescribed to 10 (4.8%) patients. Beta-blockers were prescribed to 188 (90.8%) patients: bisoprolol - 149 (72.0%), metoprolol succinate - 2 (1%), carvedilol - 1 (0.5%). In addition, 36 (17.4%) patients were prescribed metoprolol tartrate not recommended for the treatment of heart failure. Diuretic therapy was prescribed in 200 (96.6%) patients: furosemide - 177 (85.5%), torasemide - 22 (10.6%), indapamide - 1 (0.5%). Mineralocorticoid receptor antagonist spironolactone was recommended 165 (79.7%) patients. Despite the persistence of heart failure III-IV NYHA functional class despite combined medical treatment in 95.1% of patients, the angiotensin receptor and neprilysin inhibitor and/or If-channel blockers and/or cardiac resynchronization therapy weren’t recommended. For glycemic control, metformin was prescribed to 28 (13.5%) patients, gliclazide SR - 53 (25.6%), insulin - 59 (28.5%); combination of metformin and gliclazide SR - 4 (1.9%), metformin and insulins - 5 (2.4%), gliclazide SR and insulins - 5 (2.4%), glimepiride and insulins - 3 (1.5%) patient. During 132 (92; 200) weeks follow up after discharge 107 (67.3%) patients died. The number of deaths was less - 19 (35.2%) in the group of patients whom the therapy in accordance with guidelines was prescribed and who were compliant compared to 88 (83.8%) deaths in others - p (x2)<0.000001. Conclusion. In order to improve the prognosis in patients with heart failure and diabetes mellitus in real clinical practice, it is necessary to carry out treatment strictly in accordance with current guidelines and use the modern achievements in cardiology, including ARNI, If-channel blockers, CPT and etc. Key words: chronic heart failure, diabetes mellitus, guidelines, reduced and middle left ventricular ejection fraction, drug therapy, prognosis, real practice. For citation: Reznik E.V., Lazarev V.A., Kalova M.R., Nikitin I.G. Management of patients with chronic heart failure and diabetes mellitus from the standpoint of modern recommendations and in real clinical practice. Consilium Medicum. 2020; 22 (5): 50-56. DOI: 10.26442/20751753.2020.5.200198

chronic heart failure, diabetes mellitus, guidelines, reduced and middle left ventricular ejection fraction, drug therapy, prognosis, real practice