Management of acute decompensated heart failure in inpatients with diabetes
A recent WHO report estimated that 422 million adults were living with diabetes in 2014 globally, compared to 108 million in 1980. The prevalence of diabetes is also high in the hospital setting. The International Diabetes Federation estimated that in 2014 diabetes expenditure reached US $ 612 billion. In 2008-2009, Australia spent $647 million (AU) on inpatients with diabetes alone, excluding outpatient costs and pharmaceutical costs. Australia’s ageing population and the increasing prevalence of diabetes comes at considerable personal and economic cost to individuals and the community.
From the Austin Health Diabetes Discovery cohort, patients with a principle diagnosis of decompensated heart failure over a 30 month period revealed that almost 50% of inpatients admitted with decompensated heart failure had diabetes. The deadly trio of diabetes, cardiac failure and chronic kidney disease is a leading cause of morbidity, increased readmission rates and mortality in the elderly population.
We want to investigate the feasibility and safety of adding empagliflozin to inpatients with diabetes admitted with decompensated heart failure (New York Heart Association (NYHA) functional classification I to IV). This will be achieved by using the Diabetes Discovery Initiative to identify inpatients early on in the hospital admission. Inpatients will be randomized to empagliflozin 10mg versus placebo.
The trio of diabetes, decompensated heart failure and chronic renal failure is the pathway to mortality in many elderly patients. These patients are frequently readmitted to hospital with heart failure. Hospital readmissions are associated with reduced quality of life. The current study aims to improve outcomes in this high risk group of patients.