Management of patients with diabetes and heart failure with reduced ejection fraction: An international comparison

被引:8
作者
Arnold, Suzanne V. [1 ,2 ]
Yap, Jonathan [3 ]
Lam, Carolyn S. P. [3 ,4 ,5 ]
Tang, Fengming [1 ,2 ]
Tay, Wan T. [3 ]
Teng, Tiew H. K. [3 ]
McGuire, Darren K. [6 ]
Januzzi, James L. [7 ]
Fonarow, Gregg C. [8 ]
Masoudi, Frederick A. [9 ]
Kosiborod, Mikhail [1 ,2 ]
机构
[1] St Lukes Mid Amer Heart Inst, 4401 Wornall Rd, Kansas City, MO 64111 USA
[2] Univ Missouri, Kansas City, MO 64110 USA
[3] Natl Heart Ctr Singapore, Singapore, Singapore
[4] Duke NUS Med Sch, Singapore, Singapore
[5] Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands
[6] Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA
[7] Massachusetts Gen Hosp, Boston, MA 02114 USA
[8] Univ Calif Los Angeles, Los Angeles, CA USA
[9] Univ Colorado Anschutz Med Campus, Aurora, CO USA
基金
英国医学研究理事会;
关键词
diabetes mellitus; heart failure; quality of care; registries; systolic dysfunction; CARDIOVASCULAR OUTCOMES; DEATH; METFORMIN; MELLITUS; RISK; THIAZOLIDINEDIONES; EMPAGLIFLOZIN; ASSOCIATION; STATINS; DRUGS;
D O I
10.1111/dom.13511
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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%; beta-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 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.
引用
收藏
页码:261 / 266
页数:6
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