Congestive heart failure Sodium-glucose co-transporter 2 inhibitors

Overview

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. 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 OMT 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, in addition to OMT with an ACE-I/ARNI, a beta-blocker and an MRA, for patients with HFrEF regardless of diabetes status. The diuretic/natriuretic properties of SGLT2 inhibitors may offer additional benefits in reducing congestion and may allow a reduction in loop diuretic requirement.135

Sodium-glucose co-transporter 2 inhibitors

Indications for Sodium-glucose co-transporter 2 inhibitors

A patient should be on a Sodium-glucose co-transporter 2 inhibitor if: 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.