August 23, 2018Open Access
View Full PaperManagement of patients with diabetes and heart failure with reduced ejection fraction: An international comparison
Key Result
Guideline-directed medical therapy use for HFrEF was lower in low-income Asian countries than in the US and high-income Asian countries (e.g., β-blockers: 69% vs 91% vs 87%, P<0.001).
Study Design
Type
Cohort (n=31,112)
Multicenter
Yes
Structured PICO
How do the treatment patterns and use of guideline-directed medical therapies compare between patients with diabetes and HFrEF in the United States versus Asia?
P
Population
31,112 adults with diabetes and heart failure with reduced ejection fraction (HFrEF, ejection fraction <40%), comprising 28,877 patients from a US-based registry (2013-2016) and 2,235 patients from a multi-national Asian registry (2010-2016).
O
Outcome
Rates of use of guideline-directed medical therapies and diabetes medications
There are significant regional variations and overall underutilization of guideline-directed medical therapies and newer diabetes medications in patients with diabetes and HFrEF across the US and Asia.
Main Result
p-value: p=<0.001
Abstract
AIMS: To compare the management of patients with diabetes and heart failure with reduced ejection fraction (HFrEF) in the United States and Asia to understand variations in treatment patterns across different healthcare systems. MATERIALS AND METHODS: Our cohort included patients with diabetes and HFrEF (ejection fraction <40%) from a US-based registry of adults with diabetes (2013-2016, electronic health records) and a multi-national Asian registry of adults with heart failure (2010-2016, prospective registry). Asian countries were categorized as high income (HI) or low income (LI), according to the United Nations classification. Rates of use of guideline-directed medical therapies (determined through review of active medication lists) were compared across regions. RESULTS: Patients with diabetes and HFrEF in the United States (n = 28 877) were older, had higher body mass indices, and were more likely to have coronary disease than those in Asia (n = 2235). Compared with US patients, the use of guideline-directed medical therapy for HFrEF was lower in patients in LI Asian countries (angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers: patients in the United States, 77% vs. patients in HI Asian countries, 76% vs patients in LI Asian countries, 69%; β-blockers: patients in the United States, 91% vs. patients in HI Asian countries, 87% vs. patients in LI Asian countries, 69%; P < 0.001 for both). Insulin was used more commonly in the United States (44% vs. 24% vs. 25%, respectively; P < 0.001), whereas sulphonylureas were more often prescribed in Asian countries (42% vs. 52% vs. 54%; respectively, P < 0.001). Thiazolidinediones were prescribed in 6% of US patients compared with <1% of patients in Asia. The use of newer diabetes medications was <5% in all. CONCLUSION: In both the United States and Asia, opportunities for improvement in the use of evidence-based therapies exist for patients with both diabetes and HFrEF. Effective tools to guide medication choices for these complex, high-risk patients could have substantial impact on quality and outcomes.