Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology

Seferović, Petar; Ponikowski, Piotr; Anker, Stefan D.; Bauersachs, Johann; Chioncel, Ovidiu; Cleland, John G.F.; Boer, Rudolf A. de; Drexel, Heinz; Gal, Tuvia Ben; Hill, Loreena; Jaarsma, Tiny; Jankowska, Ewa A.; Anker, Markus S.; Lainščak, Mitja; Lewis, Basil S.; McDonagh, Theresa A.; Metra, Marco; Miličić, Davor; Mullens, Wilfried; Piepoli, Massimo F; Rosano, Giuseppe; Ruschitzka, Frank; Volterrani, Maurizio; Voors, Adriaan A.; Filippatos, Gerasimos; Coats, Andrew J.S.

doi:10.1002/ejhf.1531

Cited by 542 publications

(533 citation statements)

References 100 publications

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“…Hence, strategies to attenuate deleterious impact of T2DM (e.g. adoption of healthy lifestyles, management of obesity, early consideration of medications with proven CV benefits, such as sodium–glucose co‐transporter type 2 inhibitors), need to be further explored to provide a comprehensive risk reduction in AF …”

Section: Discussionmentioning

confidence: 99%

Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

Polovina

Lund

Đikić³

et al. 2019

European J of Heart Fail

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Aims Impact of type 2 diabetes mellitus (T2DM) on non‐thromboembolic outcomes in atrial fibrillation (AF) is insufficiently explored. This prospective cohort study of AF patients aimed (i) to analyse the association between T2DM and heart failure (HF) events (including new‐onset HF), and all‐cause and cardiovascular mortality, (ii) to assess the impact of baseline T2DM treatment on outcomes, and (iii) to explore characteristics of new‐onset HF phenotypes in relation to T2DM status. Methods and results Of 1803 AF patients (515/1288, with/without prior HF), 389 (22%) had T2DM at baseline. After 5 years of median follow‐up, T2DM patients had an 85% greater risk of HF events [adjusted hazard ratio (aHR) 1.85; 95% confidence interval (CI) 1.51–2.28; P < 0.001], including a 45% increased risk for new‐onset HF (1.45; 1.17–2.28; P = 0.015). T2DM conferred a 56% higher all‐cause (1.56, 1.22–2.01; P = 0.003) and a 48% higher cardiovascular mortality (1.48; 1.34–1.93; P = 0.007). Fine–Gray analysis, with mortality as a competing risk, confirmed greater HF risk among T2DM patients. All risks were highest among insulin‐treated patients. The prevalence of new‐onset HF phenotypes was as follows: 67% preserved ejection fraction (HFpEF), 20% mid‐range ejection fraction (HFmrEF) and 13% reduced ejection fraction (HFrEF). On time‐dependent Cox regression, adjusted for baseline characteristics and an interim acute coronary event, T2DM increased aHRs for new‐onset HFpEF (2.38; 1.30–4.58; P <0.001) and the combined HFmrEF/HFrEF (1.77; 1.11–3.62; P = 0.017). Conclusions Atrial fibrillation patients with T2DM have independently increased risk of new‐onset/recurrent HF events, cardiovascular and all‐cause mortality, particularly when insulin‐treated. The prevailing phenotype of new‐onset HF was HFpEF; T2DM conferred higher risk of both HFpEF and HFmrEF/HFrEF.

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Section: Discussionmentioning

confidence: 99%

Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

Polovina

Lund

Đikić³

et al. 2019

European J of Heart Fail

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“…This beneficial effect has already been acknowledged for empagliflozin in the 2016 ESC guidelines for the diagnosis and treatment of HF and in the guidelines for CV prevention, which have recommended its use in patients with T2DM to delay the onset of HF. In line with emerging clinical trial data, the 2019 expert consensus report from the ESC Heart Failure Association has extended this recommendation to all three SGLT‐2 inhibitors . Likewise, the 2018 American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) consensus statement has positioned SGLT‐2 inhibitors as the preferred treatment of T2DM in patients with known HF or at risk of HF .…”

Section: A Suggested Approach To Glucose‐lowering Therapy In Patientsmentioning

confidence: 98%

European Society of Cardiology/Heart Failure Association position paper on the role and safety of new glucose‐lowering drugs in patients with heart failure

Seferović

Coats

Ponikowski

et al. 2019

European J of Heart Fail

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Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and associated with considerable morbidity and mortality. Significant advances have recently occurred in the treatment of T2DM, with evidence of several new glucose‐lowering medications showing either neutral or beneficial cardiovascular effects. However, some of these agents have safety characteristics with strong practical implications in HF [i.e. dipeptidyl peptidase‐4 (DPP‐4) inhibitors, glucagon‐like peptide‐1 receptor agonists (GLP‐1 RA), and sodium–glucose co‐transporter type 2 (SGLT‐2) inhibitors]. Regarding safety of DPP‐4 inhibitors, saxagliptin is not recommended in HF because of a greater risk of HF hospitalisation. There is no compelling evidence of excess HF risk with the other DPP‐4 inhibitors. GLP‐1 RAs have an overall neutral effect on HF outcomes. However, a signal of harm suggested in two small trials of liraglutide in patients with reduced ejection fraction indicates that their role remains to be defined in established HF. SGLT‐2 inhibitors (empagliflozin, canagliflozin and dapagliflozin) have shown a consistent reduction in the risk of HF hospitalisation regardless of baseline cardiovascular risk or history of HF. Accordingly, SGLT‐2 inhibitors could be recommended to prevent HF hospitalisation in patients with T2DM and established cardiovascular disease or with multiple risk factors. The recently completed trial with dapagliflozin has shown a significant reduction in cardiovascular mortality and HF events in patients with HF and reduced ejection fraction, with or without T2DM. Several ongoing trials will assess whether the results observed with dapagliflozin could be extended to other SGLT‐2 inhibitors in the treatment of HF, with either preserved or reduced ejection fraction, regardless of the presence of T2DM. This position paper aims to summarise relevant clinical trial evidence concerning the role and safety of new glucose‐lowering therapies in patients with HF.

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“…1 Consequently, guidelines recommended switching from angiotensin-converting enzyme inhibitor (ACE-I) to sacubitril/valsartan to further reduce the risk of HF hospitalization and death in ambulatory patients with systolic HF who remain symptomatic despite optimal treatment with ACE-I, beta-blocker, and mineralocorticoid receptor antagonist (MRA). 4 On the other hand, in the PARADIGM-HF trial, 56% of patients were treated with MRA. In fact, the recent update on HF 2019 indicates that initiation of sacubitril/valsartan rather than an ACE-I may be considered for patients hospitalized with new-onset HF or decompensated HF.…”

mentioning

confidence: 99%

Switching to sacubitril/valsartan or adding aldosterone antagonist: which first?

2019

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Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology

Cited by 542 publications

References 100 publications

Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

European Society of Cardiology/Heart Failure Association position paper on the role and safety of new glucose‐lowering drugs in patients with heart failure

Switching to sacubitril/valsartan or adding aldosterone antagonist: which first?

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