title: Heart failure therapy in diabetic patients-comparison with the recent ESC/EASD guideline.
abstract: BACKGROUND
  To assess heart failure therapies in diabetic patients with preserved as compared to impaired systolic ventricular function.
  
  
  METHODS
  3304 patients with heart failure from 9 different studies were included (mean age 63 ± 14 years); out of these, 711 subjects had preserved left ventricular ejection fraction (≥ 50%) and 994 patients in the whole cohort suffered from diabetes.
  
  
  RESULTS
  The majority (>90%) of heart failure patients with reduced ejection fraction (SHF) and diabetes were treated with an ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) or with beta-blockers. By contrast, patients with diabetes and preserved ejection fraction (HFNEF) were less likely to receive these substance classes (p < 0.001) and had a worse blood pressure control (p < 0.001). In comparison to patients without diabetes, the probability to receive these therapies was increased in diabetic HFNEF patients (p < 0.001), but not in diabetic SHF patients. Aldosterone receptor blockers were given more often to diabetic patients with reduced ejection fraction (p < 0.001), and the presence and severity of diabetes decreased the probability to receive this substance class, irrespective of renal function.
  
  
  CONCLUSIONS
  Diabetic patients with HFNEF received less heart failure medication and showed a poorer control of blood pressure as compared to diabetic patients with SHF. SHF patients with diabetes were less likely to receive aldosterone receptor blocker therapy, irrespective of renal function.
authors.affiliation: Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany. fedelmann@med.uni-goettingen.de
authors.forename: Frank
authors.initials: F
authors.lastname: Edelmann
authors.forename: Rolf
authors.initials: R
authors.lastname: Wachter
authors.forename: Hans-Dirk
authors.initials: HD
authors.lastname: Düngen
authors.forename: Stefan
authors.initials: S
authors.lastname: Störk
authors.forename: Annette
authors.initials: A
authors.lastname: Richter
authors.forename: Raoul
authors.initials: R
authors.lastname: Stahrenberg
authors.forename: Till
authors.initials: T
authors.lastname: Neumann
authors.forename: Claus
authors.initials: C
authors.lastname: Lüers
authors.forename: Christiane E
authors.initials: CE
authors.lastname: Angermann
authors.forename: Felix
authors.initials: F
authors.lastname: Mehrhof
authors.forename: Götz
authors.initials: G
authors.lastname: Gelbrich
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005858:Germany; D005919:Glomerular Filtration Rate; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D013318:Stroke Volume; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D002317:Cardiovascular Agents