The impact of diabetes on heart failure development: The cardio-renal-metabolic connection

Valensi, P.; Prévost, Gaëtan; Pinto, Sara; Donal, Erwan

doi:10.1016/j.diabres.2021.108831

Cited by 9 publications

(16 citation statements)

References 151 publications

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“…Moreover, Valensi et al (2021) has advocated the benefits of SGLT2is in HF to prevent renal decline, improving cardiovascular prognosis whilst improving chronic kidney disease outcomes. Furthermore, Renin Angiotensin Aldosterone System inhibitors (RAASi) including ACEi, ARB, ARNI, retard disease progression and improve prognosis reducing the risk of mortality and hospitalizations in patients with HFrEF as well as in CKD, (Maddox et al, 2021).…”

Section: Treatmentsmentioning

confidence: 99%

“…The consideration of treatments that encompass all components of CaReMe disease could reduce the risk of hospitalisations for individuals with HF and reduce cardiovascular deaths, (Valensi et al, 2021).…”

Section: Treatmentsmentioning

confidence: 99%

“…A collaborative cardio-renal virtual MDT approach has shown that consensus decision making leads to a reduced need for multiple clinic attendances for cardio-renal syndrome, (Sankaranarayanan, Douglas and Wong, 2020). The need for multispecialty approaches is clear, necessitating a call for cardiologists, diabetologists and nephrologists to collaborate and construct effective holistic strategies, in a bid to reduce the affliction of the CaReMe processes, (Valensi, 2021), such goals cannot be achieved without multidisciplinary support. Rangaswami, Tuttle and Vaduganathan's (2020) paper suggests a more collegiate model of care involving physician or advanced practice provider, dietician, clinical pharmacist, care navigator, and administrative representative from all three specialties (fig1).…”

Section: Collaborative Carementioning

confidence: 99%

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Cardiorenal metabolic syndrome: reaching a consensus in shared care

Lavery

Jones

Sankaranarayanan

2022

British Journal of Cardiac Nursing

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Cardiorenai metabolic syndrome is a group of interactive conditions affecting cardiovascular, renal and metabolic systems. Treatment for this multidimensional syndrome is complex, partly as a result of the current lack of definition and inclusion and exclusion criteria. Symptoms can fluctuate and follow a nonconforming pattern, and treatment is dependent on the severity of the underlying conditions involved. A multidisciplinary service model can integrate care for patients with cardiorenal metabolic syndrome and promote shared decision making. Research indicates that the use of an integrated care model also has the potential to improve clinical outcomes, while strategies such as interdisciplinary education and the promotion of self-management opportunities for individuals can improve quality of life.

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Section: Treatmentsmentioning

confidence: 99%

Section: Treatmentsmentioning

confidence: 99%

Section: Collaborative Carementioning

confidence: 99%

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Cardiorenal metabolic syndrome: reaching a consensus in shared care

Lavery

Jones

Sankaranarayanan

2022

British Journal of Cardiac Nursing

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“…The incremental impact and the intertwinement of metabolic diseases have led to the terminology of cardio–renal–metabolic disease 3 . This novel paradigm conveys that not only HF, chronic kidney disease (CKD), and type 2 diabetes (T2D) frequently co‐exist in patients but also they share common risk factors, such as central obesity, dyslipidaemia, hypertension, smoking, and inflammation, thereby heavily impacting clinical outcome 3,4 . As such, the presence of T2D conveys a more than two‐fold risk of developing HF and worsens its clinical outcome, resulting in a higher mortality risk for T2D patients vs. people without T2D 5,6 .…”

Section: Introductionmentioning

confidence: 99%

“…As such, the presence of T2D conveys a more than two‐fold risk of developing HF and worsens its clinical outcome, resulting in a higher mortality risk for T2D patients vs. people without T2D 5,6 . Similarly, the presence of CKD, characterized by the presence of albuminuria and/or impaired renal function, is associated with an increased risk of developing CVD and HF, HF hospitalization, and CV death in patients with HF 4,7 . Finally, HF also impacts outcomes in patients with CKD and T2D, and the combination of HF and CKD conveys the highest risk of CV‐related and all‐cause mortality for patients with T2D, who were initially free of CVD and renal disease 4,8 …”

Section: Introductionmentioning

confidence: 99%

Cardio–renal–metabolic syndrome: clinical features and dapagliflozin eligibility in a real‐world heart failure cohort

et al. 2023

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AimsThe Cardiovascular Outcomes Retrospective Data analysIS in Heart Failure (CORDIS-HF) is a single-centre retrospective study aimed to (i) clinically characterize a real-world population with heart failure (HF) with reduced (HFrEF) and mildly reduced ejection fraction (HFmrEF), (ii) evaluate impact of renal-metabolic comorbidities on all-cause mortality and HF readmissions, and (iii) determine patients' eligibility for sodium-glucose cotransporter 2 inhibitors (SGLT2is). Methods and resultsUsing a natural language processing algorithm, clinical data of patients diagnosed with HFrEF or HFmrEF were retrospectively collected from 2014 to 2018. Mortality and HF readmission events were collected during subsequent 1 and 2 year follow-up periods. The predictive role of patients' baseline characteristics for outcomes of interest was assessed using univariate and multivariate Cox proportional hazard models. Kaplan-Meier analysis was used to determine if type 2 diabetes (T2D) and chronic kidney disease (CKD) impacted mortality and HF readmission rates. The European SGLT2i label criteria were used to assess patients' eligibility. The CORDIS-HF included 1333 HF patients with left ventricular ejection fraction (LVEF) < 50% (413 HFmrEF and 920 HFrEF), who were predominantly male (69%) with a mean [standard deviation (SD)] age of 74.7 (12.3) years. About one-half (57%) of patients presented CKD and 37% T2D. The use of guideline-directed medical therapy (GDMT) was high (76-90%). HFrEF patients presented lower age [mean (SD): 73.8 (12.4) vs. 76.7 (11.6) years, P < 0.05], higher incidence of coronary artery disease (67% vs. 59%, P < 0.05), lower systolic blood pressure [mean (SD): 123 (22.6) vs. 133 (24.0) mmHg, P < 0.05], higher N-terminal pro-hormone brain natriuretic peptide (2720 vs. 1920 pg/mL, P < 0.05), and lower estimated glomerular filtration rate [mean (SD): 51.4 (23.3) vs. 54.1 (22.3) mL/min/1.73 m 2 , P < 0.05] than those with HFmrEF. No differences in T2D and CKD were detected. Despite optimal treatment, event rates for the composite endpoint of HF readmission and mortality were 13.7 and 8.4/100 patient years. The presence of T2D and CKD negatively impacted all-cause mortality [T2D: hazard ratio (HR) = 1.49, P < 0.01; CKD: HR = 2.05, P < 0.001] and hospital readmission events in all patients with HF. Eligibility for SGLT2is dapagliflozin and empagliflozin was 86.5% (n = 1153) and 97.9% (n = 1305) of the study population, respectively. Conclusions This study identified high residual risk for all-cause mortality and hospital readmission in real-world HF patients with LVEF < 50% despite GDMT. T2D and CKD aggravated the risk for these endpoints, indicating the intertwinement of HF with CKD and T2D. SGLT2i treatment that clinically benefits these different disease conditions can be an important driver to lower mortality and hospitalizations in this HF population.

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Cardio‐renal‐metabolic disease in primary care setting

Ibrahim,

Ba‐Essa,

Baker

et al. 2023

Diabetes Metabolism Res

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In the primary care setting providers have more tools available than ever before to impact positively obesity, diabetes, and their complications, such as renal and cardiac diseases. It is important to recognise what is available for treatment taking into account diabetes heterogeneity. For those who develop type 2 diabetes (T2DM), effective treatments are available that for the first time have shown a benefit in reducing mortality and macrovascular complications, in addition to the well‐established benefits of glucose control in reducing microvascular complications. Some of the newer medications for treating hyperglycaemia have also a positive impact in reducing heart failure (HF). Technological advances have also contributed to improving the quality of care in patients with diabetes. The use of technology, such as continuous glucose monitoring systems (CGM), has improved significantly glucose and glycated haemoglobin A1c (HbA1c) values, while limiting the frequency of hypoglycaemia. Other technological support derives from the use of predictive algorithms that need to be refined to help predict those subjects who are at great risk of developing the disease and/or its complications, or who may require care by other specialists. In this review we also provide recommendations for the optimal use of the new medications; sodium‐glucose co‐transporter‐2 inhibitors (SGLT2i) and Glucagon‐like peptide‐receptor agonists 1 (GLP1RA) in the primary care setting considering the relevance of these drugs for the management of T2DM also in its early stage.

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The impact of diabetes on heart failure development: The cardio-renal-metabolic connection

Cited by 9 publications

References 151 publications

Cardiorenal metabolic syndrome: reaching a consensus in shared care

Cardiorenal metabolic syndrome: reaching a consensus in shared care

Cardio–renal–metabolic syndrome: clinical features and dapagliflozin eligibility in a real‐world heart failure cohort

Cardio‐renal‐metabolic disease in primary care setting

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