Evaluation and Management of Patients With Diabetes and Heart Failure: A Korean Diabetes Association and Korean Society of Heart Failure Consensus Statement

Figures

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  Figure 1. Estimated prevalence of HF from 2002 to 2018 in Korea. The estimated prevalence of HF was 2.24% in 2018. Regarding the sex, the prevalence of HF was 2.31% in women and 2.16% in men. Furthermore, there has been a continuous increase in the HF prevalence from 0.77% in 2002 to 2.24% in 2018. Data are modified from the Heart failure statistics in Korea, 2020 and obtained permission to use the data from International Journal of Heart Failure.7) HF = heart failure.

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  Figure 2. The diagnostic algorithm for patients with suspected HF. Adopted and modified from 2022 Korean Society of Heart Failure Guideline for the Management of Heart Failure (https://www.kshf.or.kr/news/news_01.php?boardid=ksnotice&mode=view&idx=55). HF = heart failure; ECG = electrocardiography; BNP = B-type natriuretic peptide; NT-proBNP = N-terminal pro B-type natriuretic peptide; CAD = coronary artery disease; DM = diabetes mellitus; LVEF = left ventricular ejection fraction. *Risk factors for HF include CAD, DM, dyslipidemia, hypertension, chest radiation, cardiotoxic drugs, infections, excessive alcohol intake, obesity, and cigarette smoking; †Typical symptoms of HF include breathlessness, orthopnea, paroxysmal nocturnal dyspnea, reduced exercise tolerance, fatigue, tiredness, and ankle swelling; ‡Abnormal ECG findings include atrial fibrillation, Q waves, LV hypertrophy, and a widened QRS complex that increases the likelihood of a diagnosis of HF and may also guide therapy; §Values for the diagnosis of acute HF: BNP ≥100 pg/mL, NT-proBNP ≥300 pg/mL and rule-in values of NT-proBNP (age-adjusted threshold) for the diagnosis of acute HF: >450 pg/mL if aged <55 years, >900 pg/mL if…

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  Figure 3. Therapeutic algorithm for patients with HFrEF. Adopted and modified from 2022 Korean Society of Heart Failure Guideline for the Management of Heart Failure (https://www.kshf.or.kr/news/news_01.php?boardid=ksnotice&mode=view&idx=55). HFrEF = heart failure reduced ejection fraction; ARNI = angiotensin receptor-neprilysin inhibitor; ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; MRA = mineralocorticoid receptor antagonist; SGLT2I = sodium-glucose co-transporter 2 inhibitors; GDM = guideline-directed medication; NYHA = New York Heart Association; ICD = implantable cardioverter-defibrillator; CRT-D = cardiac resynchronization therapy with defibrillator; CRT-P = cardiac resynchronization therapy with pacemaker; NSR = normal sinus rhythm; HR = heart rate; GDMT = guideline-directed medical treatment; SR = sinus rhythm; AF = atrial fibrillation; LVAD = left ventricular assist device. *ARB is recommended as a replacement if patients are unable to tolerate ACE-I or ARNI. Strategies for the initiation and titration of disease-modifying therapy are described in more detail in Supplementary Figure 2.