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Antihyperglycemic Medication Use Among Medicare Beneficiaries With Heart Failure, Diabetes Mellitus, and Chronic Kidney Disease

Authors :
Lesley H. Curtis
Priyesh A. Patel
Gregg C. Fonarow
Bradley G. Hammill
Prateeti Khazanie
Adrian F. Hernandez
Li Liang
Clyde W. Yancy
Deepak L. Bhatt
Source :
Circulation. Heart failure, vol 9, iss 7
Publication Year :
2016
Publisher :
eScholarship, University of California, 2016.

Abstract

Background— Diabetes mellitus, heart failure (HF), and chronic kidney disease are common comorbidities, but overall use and safety of antihyperglycemic medications (AHMs) among patients with these comorbidities are poorly understood. Methods and Results— Using Get With the Guidelines-Heart Failure and linked Medicare Part D data, we assessed AHM use within 90 days of hospital discharge among HF patients with diabetes mellitus discharged from Get With the Guidelines-Heart Failure hospitals between January 1, 2006, and October 1, 2011. We further summarized use by renal function and assessed renal contraindicated AHM use for patients with estimated glomerular filtration rate 2 . Among 8791 patients meeting inclusion criteria, the median age was 77 (interquartile range 71–83), 62.3% were female, median body mass index was 29.7 (interquartile range 25.5–35.3), median hemoglobin A1c was 6.8 (interquartile range 6.2–7.8), and 34% had ejection fraction 2 , 35.4% filled prescriptions for renal contraindicated AHMs per prescribing information, though there was a trend toward lower renal contraindicated AHM use over time (Cochran–Mantel–Haenszel row-mean score test P =0.048). Although use of other AHMs was low overall, thiazolidinediones were used in 6.6% of HF patients, and dipeptidyl peptidase-4 inhibitors were used in 5.1%, with trends for decreasing thiazolidinedione use and increased dipeptidyl peptidase-4 inhibitor use over time ( P Conclusions— Treatment of diabetes mellitus in patients with HF and chronic kidney disease is complex, and these patients are commonly treated with renal contraindicated AHMs, including over 6% receiving a thiazolidinedione, despite known concerns regarding HF. More research regarding safety and efficacy of various AHMs among HF patients is needed.

Details

Database :
OpenAIRE
Journal :
Circulation. Heart failure, vol 9, iss 7
Accession number :
edsair.doi.dedup.....32eb8ac7783e8a7ac136212a30d49005