Purpose. Aim of the present report was to analyze the prevalence and characteristics of these conditions in HFrEF patients enrolled across Europe.
Methods. Six HF specialists of 3 European countries (1 from Austria, 1 from France, 2 from North Italy, and 2 from South Italy) were involved in patients’ enrollment. In particular, they enrolled consecutive HFrEF patients seen from November 2016 to January 2017 fulfilling the subsequent criteria: 1) age =18 years; 2) EF =40%; 3) stable clinical conditions; 4) HF diagnosis since at least 6 months; 5) no acute coronary syndrome in the previous 3 months. On the same day patients underwent venous blood sample collection to assess fasting glucose, fasting insulin and glycated hemoglobin. IR was assessed through the evaluation of HOMA-IR, calculated by the formula [fasting Glucose (mmol/L) × fasting Insulin (mIU/L)/22.5], and the presence of IR was defined as HOMA-IR value >2.5.
Results. Two hundred twenty-two HFrEF patients were included in the analysis (72.5% M, mean age 66.5±12.4 yrs, mean EF 30.9±6.7%). The etiology of HF was ischemic in 131 (59%) patients, an idiopathic dilated cardiomyopathy in 75 (33.8%) subjects, and in the remaining cases other causes were identified; 71% of patients were in NYHA class I-II and 29% in NYHA III. Eighty patients (36%) exhibited DM (93.7% type 2 DM, 6.3% type 1 DM) with no significant differences among countries (47 vs. 37 vs. 34% in Austria, France and Italy, respectively; p=ns). Mean fasting glycemia was 141±44 mg/dl, mean HbA1c 7.5±1.7% and mean fasting insulin 20±22 uUI/ml; 34% were on treatment with oral antidiabetics alone, 20% with oral antidiabetic plus insulin, 21% with insulin alone, and the remaining patients were on diet control. HF was of ischemic etiology in 76% of cases, and an adequate, however not optimal HF therapy was prescribed (59% ACE-i or ARBs, 74% beta-blockers, 40% MRAs, 12% LCZ-696). As regards to IR, among non-diabetics the prevalence of IR was 46% with mean HOMA index of 3.1±2.8, mean fasting glycemia of 95±23 mg/dl and mean fasting insulinemia of 12±10 uUI/ml. HF was of ischemic etiology in 55% of cases and HF treatment was not optimal also in this group (65% ACE-i or ARBs, 73% beta-blockers, 30% MRAs, 0% LCZ-696).
Conclusions. Diabetes mellitus and insulin resistance are common comorbidities of European HF patients with similar distribution across countries and still not optimal HF treatment. More efforts are required to prompt recognize glucose metabolism abnormalities in HF and to optimize HF management in these subgroups to improve patients’ quality of life and long-term prognosis.