Metformin and Thiazolidinedione Use in Medicare Patients With Heart Failure

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Abstract
Although diabetes and heart failure commonly coexist, the treatment of diabetes in patients with both conditions is complicated because the popular oral insulin sensitizers are not recommended for treatment of patients with moderate-to-severe heart failure. According to the package insert, metformin is contraindicated in all patients with "heart failure requiring pharmacologic treatment" because of the increased risk of potentially lethal lactic acidosis.1 Thiazolidinediones are not recommended for patients with "New York Heart Association class III or IV status" because these agents expand intravascular volume and may exacerbate heart failure.2,3 Despite these strong admonitions, limited data suggest that metformin is often prescribed in patients with contraindications.4-6