Congestive heart failure Sodium-glucose co-transporter 2 inhibitors: Difference between revisions
Jump to navigation
Jump to search
Line 18: | Line 18: | ||
===Background=== | ===Background=== | ||
*In DAPA-HF trial- a phase 3, placebo-controlled trial- 4744 patients with NYHA class II–IV, and an LVEF ≤40% despite optimal medical therapy (OMT) were randomly assigned to receive dapagliflozin (10 mg once daily) or placebo, in addition to OMT. The primary outcome was a composite of worsening HF (hospitalization or an urgent visit resulting in i.v. therapy for HF) or cardiovascular (CV) death. Results showed that over a median of 18.2 months, dapagliflozin resulted in a 26% reduction in the primary endpoint. | *In DAPA-HF trial- a phase 3, placebo-controlled trial- 4744 patients with NYHA class II–IV, and an LVEF ≤40% despite optimal medical therapy (OMT) were randomly assigned to receive dapagliflozin (10 mg once daily) or placebo, in addition to OMT <ref name="pmid31535829">{{cite journal| author=McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA | display-authors=etal| title=Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. | journal=N Engl J Med | year= 2019 | volume= 381 | issue= 21 | pages= 1995-2008 | pmid=31535829 | doi=10.1056/NEJMoa1911303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31535829 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=32066149 Review in: Ann Intern Med. 2020 Feb 18;172(4):JC16] </ref>. The primary outcome was a composite of worsening HF (hospitalization or an urgent visit resulting in i.v. therapy for HF) or cardiovascular (CV) death. Results showed that over a median of 18.2 months, dapagliflozin resulted in a 26% reduction in the primary endpoint. | ||
*Similar benefits were seen in patients with and without diabetes. In the EMPEROR-Reduced trial, 3730 patients with NYHA class II–IV, and an LVEF ≤40% despite optimal medical therapy (OMT) were randomly assigned to receive empagliflozin (10 mg once daily) or placebo, in addition to OMT. The primary outcome was a composite of CV death or hospitalization for worsening HF. Results showed that over a median of ... months empagliflozin reduced the primary endpoint by 25%. | *Similar benefits were seen in patients with and without diabetes. In the EMPEROR-Reduced trial, 3730 patients with NYHA class II–IV, and an LVEF ≤40% despite optimal medical therapy (OMT) were randomly assigned to receive empagliflozin (10 mg once daily) or placebo, in addition to OMT. The primary outcome was a composite of CV death or hospitalization for worsening HF. Results showed that over a median of ... months empagliflozin reduced the primary endpoint by 25%. | ||
*Therefore, dapagliflozin or empagliflozin are recommended for patients with HFrEF regardless of the presence or absence of diabetes, in addition to optimal medical therapy with an ACE-I/ARNI, a beta-blocker, and an MRA. SGLT2 inhibitors also have diuretic/natriuretic effects which may provide additional benefits in reducing volume overload and congestion and thus may allow a reduction in the need to loop diuretics. | *Therefore, dapagliflozin or empagliflozin are recommended for patients with HFrEF regardless of the presence or absence of diabetes, in addition to optimal medical therapy with an ACE-I/ARNI, a beta-blocker, and an MRA. SGLT2 inhibitors also have diuretic/natriuretic effects which may provide additional benefits in reducing volume overload and congestion and thus may allow a reduction in the need to loop diuretics. |
Revision as of 15:22, 29 September 2021
Editor(s)-In-Chief: C. Michael Gibson, M.S., M.D.; Associate Editor(s)-In-Chief: Mitra Chitsazan, M.D.[1]
Overview
Sodium-glucose co-transporter 2 (SGLT2) inhibitors (dapagliflozin or empagliflozin) are recommended for patients with HFrEF regardless of the presence or absence of diabetes, in addition to optimal medical therapy with an ACE-I/ARNI, a beta-blocker, and an aldosterone antagonist.
Sodium-glucose co-transporter 2 inhibitors
Indications for Sodium-glucose co-transporter 2 inhibitors
According to the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, all patients should be on a Sodium-glucose co-transporter 2 inhibitors if: [1]
1. The left ventricular ejection fraction (LVEF) is ≤ 40%
AND
2. The patient is already taking an ACE-I/ARNI, a beta-blocker, and an aldosterone antagonist.
- SGLT2 inhibitors should be administered for all patients with HFrEF regardless of diabetes status.
Background
- In DAPA-HF trial- a phase 3, placebo-controlled trial- 4744 patients with NYHA class II–IV, and an LVEF ≤40% despite optimal medical therapy (OMT) were randomly assigned to receive dapagliflozin (10 mg once daily) or placebo, in addition to OMT [2]. The primary outcome was a composite of worsening HF (hospitalization or an urgent visit resulting in i.v. therapy for HF) or cardiovascular (CV) death. Results showed that over a median of 18.2 months, dapagliflozin resulted in a 26% reduction in the primary endpoint.
- Similar benefits were seen in patients with and without diabetes. In the EMPEROR-Reduced trial, 3730 patients with NYHA class II–IV, and an LVEF ≤40% despite optimal medical therapy (OMT) were randomly assigned to receive empagliflozin (10 mg once daily) or placebo, in addition to OMT. The primary outcome was a composite of CV death or hospitalization for worsening HF. Results showed that over a median of ... months empagliflozin reduced the primary endpoint by 25%.
- Therefore, dapagliflozin or empagliflozin are recommended for patients with HFrEF regardless of the presence or absence of diabetes, in addition to optimal medical therapy with an ACE-I/ARNI, a beta-blocker, and an MRA. SGLT2 inhibitors also have diuretic/natriuretic effects which may provide additional benefits in reducing volume overload and congestion and thus may allow a reduction in the need to loop diuretics.
Dosing
SGLT2 inhibitor [1] | Starting dose | Target dose |
---|---|---|
Dapagliflozin | 10 mg QD | 10 mg QD |
Empagliflozin | 10 mg QD | 10 mg QD |
Contraindications
- ↑ 1.0 1.1 McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M; et al. (2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check
|pmid=
value (help). - ↑ McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA; et al. (2019). "Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction". N Engl J Med. 381 (21): 1995–2008. doi:10.1056/NEJMoa1911303. PMID 31535829. Review in: Ann Intern Med. 2020 Feb 18;172(4):JC16