AstraZeneca Initiative to Highlight Link Between Diabetes, Heart Failure

Heart failure (HF) is a debilitating condition, with survival rates of less than 50% after 5 years. People with type 2 diabetes (T2D) are between 2 and 5 times more likely to develop HF, and its symptoms may come upon patients slowly—shortness of breath, fatigue, or trouble sleeping could be written off as being out of shape or signs of age.

When HF finally causes chest pains and a visit to the emergency department (ED), the patient has likely been living with the disease for some time. But at that point, prevention is too late.

Turning the tide on HF will require educating both patients and primary care physicians to take prevention seriously, said Javed Butler, MD, MPH, MBA, professor and chairman of the Department of Medicine at the University of Mississippi, who spoke with The American Journal of Managed Care^® about an initiative launching this weekend between the American Heart Association (AHA) and AstraZeneca to highlight the connection between diabetes and HF.

Called Diabetes Can Break Your Heart, the initiative seeks to get doctors and patients talking about the connection between the 2 conditions, so that symptoms are not missed and treatment that could prevent HF occurs early. A Diabetes Heartbreaker tour, which will feature a virtual reality experience with immersive technology, will kick off this weekend at the AHA Scientific Sessions in Philadelphia.

Butler said the message of prevention must start with promoting healthier eating and more exercise. “I don’t think we should ever leave that message off the table,” he said. “If there are opportunities beyond lifestyle modification,” such as adding therapy to prevent HF, they should not be left to specialists, but should be pursued in the primary care setting, where most diabetes care occurs.

A recent study in JAMA Cardiology showed that deaths from HF are increasing—which Butler said is due to a variety of factors, including an aging population and a rise in obesity in the US population. Also, some patients who might have not survived heart attacks or strokes in the past now survive thanks to better cardiac care, but now live with HF as a result.

Diabetes Can Break Your Heart has more than one audience, Butler said. The first targets are doctors and nurses in primary care, who must be alert to recognize—and ask about—symptoms that might be ignored.

“If you don’t sleep well, if you’re waking up in the middle of the night, if you’re short of breath—if you’re like most of us, you would tend to ignore those symptoms as long as you can,” Butler said. “In the hurried clinical encounter, we might ask, ‘Are you doing OK?’ And they may be doing OK.”

But too often, the patient has slowly reduced expectations of what he or she should be able to do, or the patient can only maintain activities with help from others. “Unless we start probing these things,” Butler said, they will continue to be overlooked.

A second audience—patients—must be taught to stop overlooking HF symptoms as the fallout of being overweight, growing older, or unfortunate genetics. “We have to bring heart failure on to the list of diagnoses that people think about,” he said.

Data on HF treatment show there’s plenty of room for improvement, Butler said. He cited a 2018 study in the Journal of the American College of Cardiology which found that of 3518 patients on a registry of patients with HF with reduced ejection fraction, just 1% were prescribed 3 recommended therapies at the correct doses based on current clinical guidelines.

Butler is well aware of statistics that show it can take years for new evidence to make its way into clinical practice, but in today’s digital age, he finds that unacceptable.

“Any improvement is an improvement,” he said. Today, with the ACC recognizing the benefits of sodium glucose co-transporter 2 (SGLT2) inhibitors to prevent hospitalization for HF, education for clinicians becomes even more challenging; it’s not just a matter of physicians gaining knowledge, Butler said, but also a matter of getting them to prescribe a T2D therapy in a setting where they may have not used it in the past.

The final challenge is just getting physicians to remember to use new therapies. “We need better use of electronic health records,” he said, which can be used as “point of care reminder systems.”

AstraZeneca’s initiative will bring the virtual reality display to several cities in 2020 and will involve partnerships with the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, and the Association of Black Cardiologists. For more information, visit www.DiabetesHeartbreak.com.