Diabetes Metab J.  2023 Jan;47(1):10-26. 10.4093/dmj.2022.0420.

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

• Lee KS
• Noh J
• Park SM
• Choi KM
• Kang SM
• Won KC
• Cho HJ
• Moon MK
• The Committee of Clinical Practice Guidelines
• Korean Diabetes Association and Committee of Clinical Practice Guidelines
• Korean Society of Heart Failure

• KMID: 2538927
• DOI: http://doi.org/10.4093/dmj.2022.0420

Abstract

Diabetes mellitus is a major risk factor for the development of heart failure. Furthermore, the prognosis of heart failure is worse in patients with diabetes mellitus than in those without it. Therefore, early diagnosis and proper management of heart failure in patients with diabetes mellitus are important. This review discusses the current criteria for diagnosis and screening tools for heart failure and the currently recommended pharmacological therapies for heart failure. We also highlight the effects of anti-diabetic medications on heart failure.

Keyword

Diabetes mellitus; Diagnosis; Heart failure; Therapeutics

Figure

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  Fig. 1. Estimated prevalence of heart failure (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 Park et al. [7], according to Creative Commons license.

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  Fig. 2. The diagnostic algorithm for patients with suspected chronic heart failure (HF). Adopted and modified from 2022 Korean Society of Heart Failure Guideline for the Management of Heart Failure [43], with permission. ECG, electrocardiogram; 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; CT, computed tomography; HFrEF, heart failure reduced ejection fraction; HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction. aRisk factors for HF include CAD, DM, dyslipidemia, hypertension, chest radiation, cardiotoxic drugs, infections, excessive alcohol intake, obesity, and cigarette smoking, bTypical symptoms of HF include breathlessness, orthopnea, paroxysmal nocturnal dyspnea, reduced exercise tolerance, fatigue, tiredness, and ankle swelling, cAbnormal ECG findings include atrial fibrillation, Q waves, left ventricular hypertrophy, and a widened QRS complex that increases the likelihood of a diagnosis of HF and may also guide therapy, dValues 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 aged between 55 and 75 years, and >1,800 pg/mL if aged >75 years).

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  Fig. 3. Therapeutic algorithm for patients with heart failure reduced ejection fraction (HFrEF). Adopted and modified from 2022 Korean Society of Heart Failure Guideline for the Management of Heart Failure [43], with permission. ARNI, angiotensin receptor-neprilysin inhibitor; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; MRA, mineralocorticoid receptor antagonist; SGLT2, sodium-glucose co-transporter 2; GDM, guideline-directed medication; NYHA, New York Heart Association; LVEF, left ventricular ejection fraction; GDMT, guideline-directed medical treatment; 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; AF, atrial fibrillation; LVAD, left ventricular assist device. aARB is recommended as a replacement if patients are unable to tolerate ACEI or ARNI. Strategies for the initiation and titration of disease-modifying therapy are described in more detail in Supplementary Fig. 2.

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