Clinical characteristics and quality assessment of the treatment of patients with chronic heart failure with diabetes mellitus

Cover Page


Aim. A study of the clinical and instrumental characteristics and quality of treatment of patients with chronic heart failure (CHF) with diabetes mellitus.

Materials and methods. The study was conducted by using the CHF register method, which is a computer program with remote access, which allows on-line data collection on patients who have been examined and treated in primary care and in hospitals. The study included 8272 patients with CHF II–IV FC (functional class) (New York Heart Association – NYHA); among them 62% of patients were treated in hospital.

Results. The study showed that the frequency of diabetes was 21%. The main causes of CHF in diabetic patients are coronary artery disease, myocardial infarction (in anamnesis) and hypertension. These patients are more often diagnosed with III and IV CHF FC according to (NYHA) and retained LV (left ventricular) ejection fraction. The reduced ejection fraction was observed in 6.8% of cases, and the frequency of the “intermediate” LV was significantly higher than among patients with CHF and with diabetes and accounted for 18.9%. At patients with CHF with diabetes in comparison with patients with CHF without diabetes, atherosclerosis of the peripheral arteries, stroke (in anamnesis) and chronic kidney disease of stage III and IV were significantly more common.

Conclusion.Under the treatment, patients with CHF with diabetes have higher levels of SBP (systolic blood pressure), lipids and glucose in the blood plasma, indicating a lack of quality of treatment and, accordingly, the doctors are not optimally performing the clinical guidelines on treating this category of patients.

Full Text

Restricted Access

About the authors

N. V. Lazareva

National Medical Research Center for Cardiology

Author for correspondence.
ORCID iD: 0000-0002-3253-0669

Russian Federation, Moscow

к.м.н., с.н.с. лаб. мониторинга программ по снижению смертности от сердечно-сосудистых заболеваний

E. V. Oshchepkova

National Medical Research Center for Cardiology

ORCID iD: 0000-0003-4534-9890

Russian Federation, Moscow

д.м.н., проф., гл.н.с. отд. гипертоний

A. A. Orlovsky

National Medical Research Center for Cardiology

ORCID iD: 0000-0002-0794-4683

Russian Federation, Moscow

ред. научно-организационного отд.

S. N. Tereschenko

National Medical Research Center for Cardiology

ORCID iD: 0000-0001-9234-6129

Russian Federation, Moscow

д.м.н., проф., рук. отд. заболеваний миокарда и сердечной недостаточности


  1. Ho K, Anderson K. Survial after the onset of congensive heart failure in Framingham Heart Study subjects. Circulation. 1993;88:107-15.
  2. Дедов И.И., Шестакова М.В., Майорова А.Ю. Клинические рекомендации «Алгоритмы специализированной медицинской помощи больным сахарным диабетом». Сахарный диабет. 2019;22(S1). [Dedov II, Shestakova MV, Mayorov AYu. Standards of specialized diabetes. Diabetes mellitus. 2019;22(S1) (In Russ.)]. doi: 10.14341/DM20171S8/
  3. Сунцов Ю.И., Болотская Л.Л., Маслова О.В., Казаков И.В. Эпидемиология сахарного диабета и прогноз его распространенности в Российской Федерации. Сахарный диабет. 2011;1:15-8 [Suntsov YuI, Bolotskaya LL, Maslova OV, Kazakov IV. Epidemiology of diabetes mellitus and prognosis of its prevalence in the Russian Federation. Diabetes mellitus. 2011;1:15-8. (In Russ.)].
  4. Tsimihodimos V, Gonzalez-Villalpando C, Meigs J, Ferrannini E. Hypertension and Diabetes Mellitus Coprediction and Time Trajectories. Hypertension. 2018;71:422-8. doi: 10.1161/HYPERTENSIONAHA. 117.10546
  5. Herlitz J, Maimberg K, Karlson BW, et al. Mortability and morbidity during a five-year follow-up of diabetics with myocardial infarction. Acta Med Scand. 1988;224(1):31-8.
  6. Ostgren CJ, Merlo J, Råstam L, et al. Atrial fibrillation and its association with type 2 diabetes and hypertension in a Swedish community. Diabetes Obes Metab. 2004;6(5):367-74.
  7. Cavender MA, Steg PG, Smith SCJr, et al. Impact of diabetes mellitus on hospitalization for heart failure, cardiovascular events, and death: outcomes at 4 years from the Reduction of Atherothrombosis for Continued Health (REACH) registry. Circulation. 2015:8;132(10):923-31. doi: 10.1161/CIRCULATIONAHA.114.014796
  8. McAllister DA, Read S, Kerssens J, et al. Incidence of hospitalisation for heart failure and case-fatality among 3.25 million people with and without diabetes. Circulation. 2018;138(24):2774-86. doi: 10.1161/ CIRCULATIONAHA.118.034986
  9. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes d2019. Diabetes Care. 2019;42(Suppl.1):S103-S123. doi: 10.2337/dc19S010
  10. Черников А.А., Северина А.С., Шамхалова М.Ш., Шестакова М.В. Роль механизмов «метаболической памяти» в развитии и прогрессировании сосудистых осложнений сахарного диабета. Сахарный диабет. 2017;20(2):126-34 [Chernikov AA, Severina AS, Shamkhalova MS, Shestakova MV. The role of “metabolic memory” mechanisms in the development and progression of vascular complications of diabetes mellitus. Diabetes mellitus. 2017;20(2):126-34 (In Russ.)]. doi: 10.14341/7674
  11. Iribarren C, Karter AJ, Go AS, et al. Glycemic Control and Heart Failure Among Adult Patients With Diabetes. Circulation. 2001;103:2668-73. doi: 10.1161/01.CIR.103.22.2668
  12. Battiprolu PK, Gillette TG, Wang ZV, et al. Diabetic cardiomyopathy: mechanisms and therapeutic targets. Drug Discov Today Dis Mech. 2010;7(2):135-43. doi: 10.1016/j.ddmec.2010.08.001
  13. Lawson CA, Jones PW, Teece L, et al. Association Between Type 2 Diabetes and All-Cause Hospitalization and Mortality in the UK General Heart Failure Population: Stratification by Diabetic Glycemic Control and Medication Intensification. JACC Heart Fail. 2018;6(1):18-26. doi: 10.1016/j.jchf.2017.08.020
  14. Bjorck LM, Lanitis M, Lappas G, et al. Mortality Trends 1987 to 2004 in 404,480 Hospitalized Heart Failure Patients with and without Diabetes. Circulation. 2012;125:AP208 (Abstract).
  15. Vaur L, Gueret P, Lievre M, et al. Development of congestive heart failure in type 2 diabetic patients with microalbuminuria or proteinuria: observations from the DIABHYCAR (type 2 DIABetes, Hypertension, Cardiovascular Events and Ramipril) study. Diabetes Care. 2003;26:855-60. doi: 10.2337/diacare.26.3.855
  16. Ощепкова Е.В., Лазарева Н.В., Сатлыкова Д.Ф., Терещенко С.Н. Первые результаты Российского регистра хронической сердечной недостаточности. Кардиология. 2015;5:22-8 [Oshchepkova EV, Lazareva NV, Satlykova DF, Tereshchenko SN. The First Results of the Russian Register of Chronic Heart Failure. Kardiologiya. 2015;5:22-8 (In Russ.)].
  17. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. doi: 10.1093/eurheartj/ehw128
  18. Мареев В.Ю., Фомин И.В., Агеев Ф.Т. и др. Клинические рекомендации ОССН – РКО – РНМОТ. Сердечная недостаточность: хроническая (ХСН) и острая декомпенсированная (ОДСН). Диагностика, профилактика и лечение. Кардиология. 2018;58(S6) [Mareev VY, Fomin IV, Ageev FT, et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8-158 (In Russ.)]. doi: 10.18087/cardio.2475
  19. Чазова И.Е., Ощепкова Е.В., Жернакова Ю.В. Клинические рекомендации «Диагностика и лечение артериальной гипертонии». Кардиологический вестн. 2015;1:5-30 [Chazova IE, Oshchepkova EV, Zhernakova IuV. Klinicheskie rekomendatsii «Diagnostika i lechenie arterial’noi gipertonii». Kardiologicheskii vestn. 2015;1:5-30 (In Russ.)].
  20. MacDonald MR, Petrie MC, Hawkins NM, et al. Diabetes, left ventricular systolic dysfunction, and chronic heart failure. Eur Heart J. 2008;29(10):1224-40. doi: 10.1093/eurheartj/ehn156
  21. Thrainsdottir IS, Aspelund T, Thorgeirsson G, et al. The association between glucose abnormalities and heart failure in the population-based Reykjavik study. Diabetes Care. 2005;28(3):612-6. doi: 10.2337/ diacare.28.3.612
  22. Win TT, Davis HT, Laskey WK. Mortality among patients hospitalized with heart failure and diabetes mellitus: results from the National Inpatient Sample 2000 to 2010. Circ Heart Fail. 2016;9(5):e003023. doi: 10.1161/CIRCHEARTFAILURE.115.003023
  23. Johansson I, Dahlstrom U, Edner M, et al. Risk factors, treatment and prognosis in men and women with heart failure with and without diabetes. Heart. 2015;101(14):1139-48. doi: 10.1136/heartjnl-2014-307131
  24. Nichols GA, Hillier TA, Erbey JR, Brown JB. Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. Diabetes Care. 2001;24(9):1614-9.
  25. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405-12.
  26. Spinar J, Parenica J. Baseline characteristics and hospital mortality in the Acute Heart Failure Database (AHEAD) Main registry. Crit Care. 2011;15(6):291-304. doi: 10.1186/cc10584
  27. Hamaguchi S, Kinugawa S. Characteristics, management, and outcomes for patients during hospitalization due to worsening heart failure-A report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-Card). Cardiology. 2013;62(2):95-101. doi: 10.1016/j.jjcc. 2013.03.009
  28. Sato N, Kajimoto K, et al. Acute demopensated heart failure syndromes (ATTEND) registry. A prospective observational multicenter cohort study: Rationale, desing, and preliminary data. Am Heart J. 2010;159(6):949-56. doi: 10.1016/j.ahj.2010.03.019
  29. Adams Jr KF, Fonarow CC, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149(2):209-16.
  30. Abraham WT, Fonarow GC, et al. Predictor of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol. 2008;52(5):347-56. doi: 10.1016/j.jacc.2008.04.028
  31. Jonsson A, Edner M, Alehagen U, et al. Heart failure register: a valuable tool for improving the management of patients with heart failure. Eur J Heart Fail. 2010;12:25-31. doi: 10.1093/eurjhf/hfp175
  32. Ruiz-Laiglesia FJ, Sanchez-Marteles M, Perez-Calvo JI, et al. Comorbidity in heart failure. Results of the Spanish RICA Register. QJM. 2014;107(12):989-94. doi: 10.1093/qjmed/hcu127
  33. Lauthavorn P, Hengrussamee K. Thai acute decompensated heart failure registry (Thai ADHERE). J CVD Prevention Control. 2010;5:89-95. doi: 10.1016/j.cvdpc.2010.06.001
  34. Kannel WB, Abbott RD, Savage DD, McNamara PM. Coronary heart disease and atrial fibrillation: The Framingham Study. Am Heart J. 1983;106:389-96. doi: 10.1016/0002-8703(83)90208-9
  35. Engstrom CP, Persson LO, Larsson S, Sullivan M. Health-related quality of life in COPD: why both disease-specific and generic measures should be used. Eur Respir J. 2001;18(1):69-76.
  36. García-Olmos L, Alberquilla A, Ayala V, et al. Comorbidity in patients with chronic obstructive pulmonary disease in family practice: a cross sectional study. BMC Fam Pract. 2013;14-1. doi: 10.1186/1471-2296-14-11
  37. Преображенский Д.В., Воробьев П.А., Некрасова Н.И. и др. Анемия у больных с хронической сердечной недостаточностью: распространенность и клиническое значение. Клиническая геронтология. 2005;10:40-3 [Preobrazhenskiy DV, Vorobev PA, Nekrasova NI, et al. Anemiya u bolnykh s khronicheskoy serdechnoy nedostatochnostyu: rasprostranennost i klinicheskoe znachenie. Klinicheskaya gerontologiya. 2005;10:40-3 (In Russ.)].
  38. Hatamizadeh P, Fonarow GC, Budoff MJ, et al. Cardiorenal syndrome: pathophysiology and potential targets for clinical management. Nat Rev Nephrol. 2013;9(2):99-111. doi: 10.1038/nrneph.2012.279
  39. Khan SS, Xue JL, Kazmi WH, et al. Does predialysis nephrology care influence patient survival after initiation of dialysis? Kidney Int. 2005;67(3):1038-46.
  40. Anand I, McMurray J, Whitmore J, et al. Anemia and its relationship to clinical outcome in heart failure. Circulation. 2004;110(2):149-54. doi: 10.1161/01.CIR.0000134279.79571.73
  41. Maggioni A, Opasich C, Anand I, et al. Anemia in patients with heart failure: prevalence and prognostic role in a controlled trial and in clinical practice. J Card Fail. 2005;2(11):91-8.
  42. Cruz DN, Gheorghiade M, Palazzuoli A, et al. Epidemiology and outcome of the cardio-renal syndrome. Heart Fail Rev. 2011;16(6):531-42. doi: 10.1007/s10741-010-9223-1
  43. Giamouzis G, Kalogeropoulos A, Georgiopoulou V, et al. Hospitalization epidemic in patients with heart failure: risk factors, risk prediction, knowledge gaps, and future directions. J Card Fail. 2011;17(1):54-75. doi: 10.1016/j.cardfail.2010.08.010
  44. Go AS, Yang J, Ackerson LM, et al. Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study. Circulation. 2006;113(23):2713-23. doi: 10.1161/CIRCULATIONAHA.105.577577
  45. Fonarow GC, Abraham WT, Albert NM, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med. 2008;168:847-54. doi: 10.1001/archinte.168.8.847
  46. Steinberg BA, Zhao X, Heidenreich PA, et al. Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation. 2012;126(1):65-75. doi: 10.1161/CIRCULATIONAHA.111.080770
  47. Casado J, Montero M, Formiga F, et al. Función renal en pacientes con insuficiencia cardiaca:valor pronóstico. Rev Clin Esp. 2012;212(3):119-26.
  48. Damman K, Navis G, Voors AA. Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail. 2007;13(8):599608. doi: 10.1016/j.cardfail.2007.04.008
  49. McMurray JJ. Chronic kidney disease in patients with cardiac disease: a review of evidence-based treatment. Kidney Int. 2005;68(4):1419-26. doi: 10.1111/j.1523-1755.2005.00552.x
  50. Marwick T. Diabetic heart disease. Heart. 2006;92:296-300. doi: 10.1136/hrt.2005.067231
  51. Gilbert RE, Krum H. Heart failure in diabetes: effects of anti- hyperglycaemic drug therapy. Lancet. 2015;385(9982):2107-17. doi: 10.1016/S0140-6736(14)61402-1
  52. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels – updated overview and meta-analyses of randomized trials. J Hypertension. 2016;34(4):613-22. doi: 10.1097/ HJH.0000000000000881
  53. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. JACC. 2018;71(19):e127-248. doi: 10.1016/j.jacc.2017.11.006
  54. Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet. 2004;363(9426):2022-31. doi: 10.1016/S0140-6736(04)16451-9
  55. Beckett NS, Peters R, Fletcher AE, et al. Treatment of Hypertension in Patients 80 Years of Age or Older. N Engl J Med. 2008;358(18):1887-98. doi: 10.1056/NEJMoa0801369
  56. U.S. Food and Drug Administration. Guidance for Industry. Diabetes Mellitus – Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes. 2008.
  57. Seferović PM, Petrie MC, et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20:853-72. doi: 10.1002/ejhf.1170
  58. Hernandez AV, Usmani A, Rajamanickam A, Moheet A. Thiazolidinediones and risk of heart failure in patients with or at high risk of type 2 diabetes mellitus: a meta-analysis and meta-regression analysis of placebo-controlled randomized clinical trials. Am J Cardiovasc Drugs. 2011;11:115-28. doi: 10.2165/11587580-000000000-00000
  59. Scirica BM, Braunwald E, Raz I, et al. SAVOR-TIMI 53 Steering Committee and Investigators. Heart failure, saxagliptin, and diabetesmellitus: observations from the SAVOR-TIMI 53 randomized trial. Circulation. 2015;132:e198.
  60. McGuire DK, Van de Werf F, Armstrong PW, et al. Association Between Sitagliptin Use and Heart Failure Hospitalization and Related Outcomes in Type 2 Diabetes Mellitus: Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol. 2016;1(2):126-35. doi: 10.1001/jamacardio. 2016.0103
  61. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373:2117-28. doi: 10.1056/NEJMoa1504720
  62. Mahaffey KW, Neal B, Perkovic V, et al. Canagliflozin for Primary and Secondary Prevention of Cardiovascular Events: Results From the CANVAS Program (Canagliflozin Cardiovascular Assessment Study). Circulation. 2018;137(4):323-34. doi: 10.1161/CIRCULATIONAHA. 117.032038

Supplementary files

Supplementary Files Action
Fig. 1. Age distribution of patients with heart failure without diabetes and with diabetes.

Download (17KB) Indexing metadata
Fig. 2. The distribution of patients with heart failure with diabetes / without diabetes by FC CHF (NYHA).

Download (9KB) Indexing metadata
Fig. 3. LVEF in patients with heart failure II – IV FC with diabetes / without diabetes.

Download (11KB) Indexing metadata
Fig. 4. Drug therapy in patients with heart failure (II – IV FC) with diabetes / without diabetes.

Download (17KB) Indexing metadata



Abstract - 83

PDF (Russian) - 54





  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Novoslobodskaya str 31c4., Moscow, 127005, Russian Federation

Managing Editor:


© 2018 "Consilium Medicum" Publishing house

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies