25th September 2022, Dr Chee L Khoo
We looked at the Australian guidelines on management of heart failure (HF) recently and in particular, how it impacts upon the management of these patients in primary care. The guidelines recommended the four pillars of management but also reinforced the categories of HF. Did you know that the numbers that define the different categories of HF is somewhat arbitrary?…
27th January 2022, Dr Chee L Khoo
At GPVoice, we have covered the management of heart failure fairly comprehensively over the last couple of years. In particular, we explored the cardiovascular benefits of SGLT2 inhibitors in patients with type 2 diabetes (T2D) especially in patients with heart failure. Initial studies looked at patients with heart failure with reduced ejection fraction (HFrEF) although subsequent studies found the benefits was also seen in patients with preserve ejection fraction (HFpEF) although only empagliflozin has reported.…
25th September 2021, Dr Chee L Khoo
SGLT2 inhibitors (SGLT2i) have been shown to improve outcomes in patients with type 2 diabetes (T2D) and high cardiovascular risks as well as in patients with chronic kidney disease and heart failure regardless of diabetes status and independently of blood glucose levels or HbA1c. There is a little bit of a “catch” though, the eGFR.…
13th May 2020, Dr Chee L Khoo
Covid-19 have exposed the numerous risks patients with type 2 diabetes (t2D) face when the two pandemics meet head on. We have seen that patients with diabetes are over-represented in patients hospitalised with Covid-19 in Wuhan. Patients with diabetes are also affected more severely if they contracted Covid-19 especially if glycaemic control is suboptimal.…
12th December 2019, Dr Chee L Khoo
Type 2 diabetes (T2D) and heart failure (HF) are common diseases with significant morbidity and mortality. Two out of three patients with T2D have evidence of ventricular dysfunction within 5 years of diabetes diagnosis (1). Data from both observational studies and clinical trial cohorts suggest that the development of HF in patients with T2DM is associated with anywhere from a 4- to 10-fold increase in mortality risk (2,3).…
12th December 2019, Dr Chee L Khoo
EMPA-REG, CANVAS, DECLARE-TIMI 58 and VERTIS-CV are cardiovascular outcome trials (CVOTs) originally designed to demonstrate non-inferiority of SGLT2 inhibitors versus placebo on major adverse cardiovascular events (MACE). These clinical trials involving a total of > 36,000 patients with type 2 diabetes (T2D) followed for 2–5 years. Patients treated with a SGLT2 inhibitor experienced a 25–35% lower risk of hospitalisation for heart failure (HHF).…
26th May 2019, Dr Chee L Khoo
Sometimes when a drug is contraindicated for patients with low eGFR, it may mean that usage of the drug may further damage the kidneys or increase the risk of certain adverse events. For example, the use of metformin in patients with eGFR <30 significantly increase the risk of lactic acidosis. Usage of lithium in patients with impaired renal function (low eGFR) may further damage the kidneys.…
13th November 2018, Dr Chee L Khoo
It’s finally here. The Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE–TIMI 58) trial finally released their results this week at the American Heart Association (AHA) Scientific Sessions 2018. The results were most impressive but this was not just another CV outcome trial of another SGLT2 inhibitors. The results have major implications in the way we treat patients with type 2 diabetes (T2D) in general practice.…