Herzinsuffizienztherapie bei Patienten mit Diabetes

 

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Anfang diesen Jahres nahm die European Society of Cardiology das Kombinationspräparat Sacubitril/ Valsartan in ihre Leitlinien zur Behandlung der chronischen Herzinsuffizienz auf. Auch das IQWIG bescheinigte einen „beträchtlichen Zusatznutzen“, den es allerdings später aufgrund von Sensitivitätsanalysen für Diabetiker einschränkte. Welche Konsequenzen ziehen sich nun aus dieser Neueinschätzung für die Behandlung herzinsuffizienter Diabetiker im Praxisalltag?

Abstract

Sacubitril / Valsartan proofed to be an effective treatment compared to enalapril in reducing heart failure hospitalisations and mortality in patients with severe „Heart failure with reduced ejection fraction“ (HFREF). Recent European cardiology guidelines attributed a class IB recommendation for Sacubitril / Valsartan in HFREF patients who remain symptomatic despite optimal treatment with ACE-I, a beta-blocker, and a mineralocorticoid receptor antagonist. There is a significant overlap between diabetic and HFREF patients and thus, efficacy assessment of Sacubitril / Valsartan is a clinically meaningful issue in the large subgroup of HFREF patients with diabetes. We discuss the present evidence why local authorities speculated about a potential interaction between the two diseases decreasing the efficacy of sacubitril/valsartan in terms of reducing relevant end-points in this cohort. Overall, Sacubitril / Valsartan is obviously a treatment option in diabetics with HFREF. However, diabetic cardiomyopathy needs to be recognised as a specific disease condition.

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