Congestive heart failure Sodium-glucose co-transporter 2 inhibitors: Difference between revisions
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==Sodium-glucose co-transporter 2 inhibitors== | ==Sodium-glucose co-transporter 2 inhibitors== | ||
===Indications for 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: <ref name="pmid34447992">{{cite journal| author=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M | display-authors=etal| title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. | journal=Eur Heart J | year= 2021 | volume= 42 | issue= 36 | pages= 3599-3726 | pmid=34447992 | doi=10.1093/eurheartj/ehab368 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34447992 }} </ref> | |||
1. The [[left ventricular ejection fraction]] ([[LVEF]]) is ≤ 40% | 1. The [[left ventricular ejection fraction]] ([[LVEF]]) is ≤ 40% |
Revision as of 15:16, 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. 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 | Starting dose | Target dose |
---|---|---|
Dapagliflozin | 10 mg QD | 10 mg QD |
Empagliflozin | 10 mg QD | 10 mg QD |
Contraindications
- ↑ 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).