(P107) MEDICAL MANAGEMENT OF HEART FAILURE WITH CONCURRENT DIABETES MELLITUS IN CANADIAN PRIMARY CARE

Background: Heart failure (HF) and diabetes (DM) often co-exist and are associated with increased mortality and hospitalization. Although most patients are managed in primary care, the disease intersection has mainly been studied in secondary care, ambulatory registries, and selected cohorts. We therefore assessed HF and DM management in primary care using the Canadian Primary Care Surveillance Network (CPCSSN).

METHODS AND RESULTS: CPCSSN is a primary care data repository consisting of 17 electronic medical record (EMR) systems, spanning all provinces in Canada except Saskatchewan. Data on over 2 million patients are contributed quarterly to the network. Patients with HF and DM were identified using validated case definitions. The sensitivity and specificity are 90% and 93% for identifying HF, and 96% and 97% for identifying DM. Prescription of all medical therapies increased from 2010 to 2020. In patients with HF alone (n=5,319 in 2010 and n=10,699 in 2020), renin-angiotensin blockade (RAASi) increased from 79.6% to 80.3%, beta-blockers from 29.3% to 47.2%, and mineralocorticoid receptor antagonists (MRA) from 6.4% to 17.3%. In those with concurrent DM (n=2,747 in 2010 and n=9,024 in 2020), the corresponding rates were slightly higher at both time points for RAASi (88.6% to 83.5%) and MRA (9% to 19.3%), but lower for beta-blockers (24.5% to 44.8%). Sodium/glucose cotransporter 2 inhibitors (SGLT2i) were never prescribed in patients with HF alone. However, in patients with concurrent DM, prescription increased from 0.2% to 18.2%.
Prescription of loop diuretics for symptom control increased for both HF with DM and HF alone groups, from 39.5 to 64.9%, and 33.4% to 58.4% respectively.

Conclusion: To our knowledge, this is the first study on primary care management of heart failure and diabetes in Canada. Our study showed an increase uptake of all HF therapies from 2010 to 2020, despite a lack of left ventricular ejection fraction (LVEF) information. There are ongoing prescription gaps in therapies potentially indicated across the spectrum of LVEF, such as MRA and SGLT2i. While the use of MRA was similar in HF with and without DM, SGLT2i uptake in patients with HF and concurrent DM was higher compared with those with HF alone. Further medical optimization of this complex patient population in primary care is needed.