title: Uncovering heart failure with preserved ejection fraction in patients with type 2 diabetes in primary care: time for a change.
abstract: Undetected heart failure appears to be an important health problem in patients with type 2 diabetes and aged ≥ 60 years. The prevalence of previously unknown heart failure in these patients is high, steeply rises with age, and is overall higher in women than in men. The majority of the patients with newly detected heart failure have a preserved ejection fraction. A diagnostic algorithm to detect or exclude heart failure in these patients with variables from the medical files combined with items from history taking and physical examination provides a good to excellent accuracy. Annual screening appears to be cost-effective. Both unrecognised heart failure with reduced and with preserved ejection fraction were associated with a clinically relevant lower health status in patients with type 2 diabetes. Also the prognosis of these patients was worse than of those without heart failure. Existing disease-management programs for type 2 diabetes pay insufficient attention to early detection of cardiovascular diseases, including heart failure. We conclude that more attention is needed for detection of heart failure in older patients with type 2 diabetes.
authors.affiliation: Department of Scientific and Contract Research, Center for Diagnostic Support in Primary Care (SHL-Groep), Bredaseweg 165, 4872 LA, Etten-Leur, The Netherlands. Leandradewinter@yahoo.com.
authors.forename: L J M
authors.initials: LJ
authors.lastname: Boonman-de Winter
authors.affiliation: Department of Cardiology, Heart-Lung Center, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Cramer
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A W
authors.initials: AW
authors.lastname: Hoes
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: F H
authors.initials: FH
authors.lastname: Rutten
keywords: Heart failure; Preserved ejection fraction; Primary care; Screening; Type 2 diabetes