Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association

Abstract

Heart failure (HF) has been recognized as a common complication of diabetes, with a prevalence of up to 22% in individuals with diabetes and increasing incidence rates. Data also suggest that HF may develop in individuals with diabetes even in the absence of hypertension, coronary heart disease, or valvular heart disease and, as such, represents a major cardiovascular complication in this vulnerable population; HF may also be the first presentation of cardiovascular disease in many individuals with diabetes. Given that during the past decade, the prevalence of diabetes (particularly type 2 diabetes) has risen by 30% globally (with prevalence expected to increase further), the burden of HF on the health care system will continue to rise. The scope of this American Diabetes Association consensus report with designated representation from the American College of Cardiology is to provide clear guidance to practitioners on the best approaches for screening and diagnosing HF in individuals with diabetes or prediabetes, with the goal to ensure access to optimal, evidence-based management for all and to mitigate the risks of serious complications, leveraging prior policy statements by the American College of Cardiology and American Heart Association.

Figure 1

Stepwise approach for screening and diagnosis across HF stages. CXR, chest X-ray; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; hs-cTN, high-sensitivity cardiac troponin; JVD, jugular vein distension; LV, left ventricle.

Figure 2

Multidisciplinary personalized care for in individuals with HF and diabetes. DPP-4i, DPP-4 inhibitors; SUs, sulfonylureas.