Prescription patterns of diabetes medications influencing clinical outcomes of heart failure patients with reduced ejection fraction
Abstract Aims We collected the different prescription patterns of diabetes medications in a cohort of patients with heart failure with reduced ejection fraction (HFrEF) and analysed the impact of different prescription patterns on clinical outcomes. Methods and results Consecutive diabetic patients...
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doaj-23ae426cadff43258705868b165a47752021-06-09T10:10:55ZengWileyESC Heart Failure2055-58222020-04-017260461510.1002/ehf2.12617Prescription patterns of diabetes medications influencing clinical outcomes of heart failure patients with reduced ejection fractionHung‐Yu Chang0Yu‐Wen Su1An‐Ning Feng2Man‐Cai Fong3Kuan‐Chih Huang4Eric Chong5Kuan‐Chun Chen6Wei‐Hsian Yin7Heart Center Cheng Hsin General Hospital No. 45 Cheng‐Hsin Street, 112 Beitou Taipei TaiwanFaculty of Medicine, School of Medicine National Yang Ming University Taipei TaiwanHeart Center Cheng Hsin General Hospital No. 45 Cheng‐Hsin Street, 112 Beitou Taipei TaiwanHeart Center Cheng Hsin General Hospital No. 45 Cheng‐Hsin Street, 112 Beitou Taipei TaiwanHeart Center Cheng Hsin General Hospital No. 45 Cheng‐Hsin Street, 112 Beitou Taipei TaiwanDivision of Cardiology Farrer Park Hospital Singapore SingaporeHeart Center Cheng Hsin General Hospital No. 45 Cheng‐Hsin Street, 112 Beitou Taipei TaiwanHeart Center Cheng Hsin General Hospital No. 45 Cheng‐Hsin Street, 112 Beitou Taipei TaiwanAbstract Aims We collected the different prescription patterns of diabetes medications in a cohort of patients with heart failure with reduced ejection fraction (HFrEF) and analysed the impact of different prescription patterns on clinical outcomes. Methods and results Consecutive diabetic patients with HFrEF from a heart failure referral centre were retrospectively analysed between 2015 and 2016. Exclusion criteria include being lost to follow‐up, not receiving diabetes medications, and having severe renal impairment with a glomerular filtration rate < 30 mL/min/1.73 m2. Prescription of diabetes medications and the respective clinical outcomes were collected between 2016 and 2018. Among 381 patients (mean age, 64.8 ± 12.8 years; 71.9% male; mean left ventricular ejection fraction, 27.6 ± 7.0%; mean body mass index, 26.1 ± 4.7 kg/m2), the prescription rates of sodium‐glucose co‐transporter 2 inhibitor (SGLT2i) increased from 10.3% in 2016 to 17.6% in 2017 and 26.5% in 2018 (P < 0.001); the prescription rates of metformin, sulfonylurea, insulin, and dipeptidyl peptidase‐4 inhibitors did not change significantly over time. The prescription rates of metformin and SGLT2i were significantly higher in patients managed by cardiologists than non‐cardiologists (in 2018, 71.1% vs. 44.2% for metformin, 45.4% vs. 9.9% for SGLT2i, both P < 0.001). During the study period, annualized event rates of cardiovascular death or first unplanned HF hospitalization were 19.0 per 100 patient‐years. After a multivariate analysis, prescriptions of metformin {odds ratio (OR): 0.49 [95% confidence interval (CI) 0.27–0.51], P < 0.001} and SGLT2i [OR: 0.52 (95% CI 0.28–0.98), P = 0.042] were independently associated with lower annualized event rates of cardiovascular death or unplanned HF hospitalization. Conclusions Prescription patterns of diabetes medications in diabetics with HFrEF were diverse among different specialists. Prescriptions of metformin and SGLT2i were associated with favourable clinical outcomes. Our finding indicates the importance of awareness of beneficial effect of different classes of diabetes medications and collaboration between specialists in the management of diabetic HFrEF patients.https://doi.org/10.1002/ehf2.12617Heart failureSodium‐glucose co‐transporter 2 inhibitor (SGLT2i)MetforminDiabetes mellitus |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hung‐Yu Chang Yu‐Wen Su An‐Ning Feng Man‐Cai Fong Kuan‐Chih Huang Eric Chong Kuan‐Chun Chen Wei‐Hsian Yin |
spellingShingle |
Hung‐Yu Chang Yu‐Wen Su An‐Ning Feng Man‐Cai Fong Kuan‐Chih Huang Eric Chong Kuan‐Chun Chen Wei‐Hsian Yin Prescription patterns of diabetes medications influencing clinical outcomes of heart failure patients with reduced ejection fraction ESC Heart Failure Heart failure Sodium‐glucose co‐transporter 2 inhibitor (SGLT2i) Metformin Diabetes mellitus |
author_facet |
Hung‐Yu Chang Yu‐Wen Su An‐Ning Feng Man‐Cai Fong Kuan‐Chih Huang Eric Chong Kuan‐Chun Chen Wei‐Hsian Yin |
author_sort |
Hung‐Yu Chang |
title |
Prescription patterns of diabetes medications influencing clinical outcomes of heart failure patients with reduced ejection fraction |
title_short |
Prescription patterns of diabetes medications influencing clinical outcomes of heart failure patients with reduced ejection fraction |
title_full |
Prescription patterns of diabetes medications influencing clinical outcomes of heart failure patients with reduced ejection fraction |
title_fullStr |
Prescription patterns of diabetes medications influencing clinical outcomes of heart failure patients with reduced ejection fraction |
title_full_unstemmed |
Prescription patterns of diabetes medications influencing clinical outcomes of heart failure patients with reduced ejection fraction |
title_sort |
prescription patterns of diabetes medications influencing clinical outcomes of heart failure patients with reduced ejection fraction |
publisher |
Wiley |
series |
ESC Heart Failure |
issn |
2055-5822 |
publishDate |
2020-04-01 |
description |
Abstract Aims We collected the different prescription patterns of diabetes medications in a cohort of patients with heart failure with reduced ejection fraction (HFrEF) and analysed the impact of different prescription patterns on clinical outcomes. Methods and results Consecutive diabetic patients with HFrEF from a heart failure referral centre were retrospectively analysed between 2015 and 2016. Exclusion criteria include being lost to follow‐up, not receiving diabetes medications, and having severe renal impairment with a glomerular filtration rate < 30 mL/min/1.73 m2. Prescription of diabetes medications and the respective clinical outcomes were collected between 2016 and 2018. Among 381 patients (mean age, 64.8 ± 12.8 years; 71.9% male; mean left ventricular ejection fraction, 27.6 ± 7.0%; mean body mass index, 26.1 ± 4.7 kg/m2), the prescription rates of sodium‐glucose co‐transporter 2 inhibitor (SGLT2i) increased from 10.3% in 2016 to 17.6% in 2017 and 26.5% in 2018 (P < 0.001); the prescription rates of metformin, sulfonylurea, insulin, and dipeptidyl peptidase‐4 inhibitors did not change significantly over time. The prescription rates of metformin and SGLT2i were significantly higher in patients managed by cardiologists than non‐cardiologists (in 2018, 71.1% vs. 44.2% for metformin, 45.4% vs. 9.9% for SGLT2i, both P < 0.001). During the study period, annualized event rates of cardiovascular death or first unplanned HF hospitalization were 19.0 per 100 patient‐years. After a multivariate analysis, prescriptions of metformin {odds ratio (OR): 0.49 [95% confidence interval (CI) 0.27–0.51], P < 0.001} and SGLT2i [OR: 0.52 (95% CI 0.28–0.98), P = 0.042] were independently associated with lower annualized event rates of cardiovascular death or unplanned HF hospitalization. Conclusions Prescription patterns of diabetes medications in diabetics with HFrEF were diverse among different specialists. Prescriptions of metformin and SGLT2i were associated with favourable clinical outcomes. Our finding indicates the importance of awareness of beneficial effect of different classes of diabetes medications and collaboration between specialists in the management of diabetic HFrEF patients. |
topic |
Heart failure Sodium‐glucose co‐transporter 2 inhibitor (SGLT2i) Metformin Diabetes mellitus |
url |
https://doi.org/10.1002/ehf2.12617 |
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