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June 18, 2014

Management of Comorbid Diabetes Mellitus and Worsening Heart Failure

Author Affiliations
  • 1Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Division of Cardiology, Emory University, Atlanta, Georgia
JAMA. 2014;311(23):2379-2380. doi:10.1001/jama.2014.4115

Type 2 diabetes mellitus affects 25.8 million adults in the United States and accounts for attributable health care costs exceeding $174 billion.1 Although it is well established that the leading cause of death in patients with diabetes mellitus is related to cardiovascular disease, the importance of heart failure among patients with diabetes has been underappreciated. Among older individuals with diabetes mellitus, approximately 22% have heart failure.2 Conversely, the burden of heart failure constitutes more than 1 million hospital admissions annually in the United States and many more emergency department and unplanned outpatient clinic visits. In large registries of patients with worsening chronic heart failure who are receiving optimal evidence-based therapies and who are hospitalized, the prevalence of diabetes mellitus was 42%, and their postdischarge mortality and rehospitalization rates were 8% and 32%, respectively, within 60 to 90 days.3 Similar rates of diabetes, with prevalences of approximately 40%, were also seen in recent clinical trials of patients hospitalized with worsening heart failure and reduced ejection fraction,4,5 as well as those with preserved ejection fraction.6