The armamentarium for heart failure with reduced ejection fraction (HFrEF) has been relatively fixed for many years. In May 2020, dapagliflozin received Food and Drug Administration (FDA) approval for HfrEF¹ in patients with and without diabetes mellitus type II. Recently, a second sodium-glucose co-transporter 2 inhibitor (SGLT2i), empagliflozin, was found to reduce the composite endpoint of cardiovascular death or hospitalization for worsening heart failure (HF) in addition to guideline-directed medical therapy, regardless of the presence or absence of diabetes mellitus, among patients with class II-IV heart failure and left ventricular ejection fraction ≤40% in the EMPEROR-Reduced trial.² SGLT2i are not yet formally integrated into heart failure guidelines but many clinicians caring for patients with HFrEF already are or want to incorporate these agents into clinical practice to optimize patient outcomes.

SGLT2i is separately used to treat diabetes and has also shown benefit in those with chronic kidney disease. Since there may be overlap in these comorbidities with HFrEF, the difficult question becomes which provider should initiate and follow treatment with SGLT2i in those with HF.

References

1. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019;381:1995-2008.
2. Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 2020;383:1413-249.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Failure, Stroke Volume, Nephrology, Physicians, Primary Care, United States Food and Drug Administration, Ventricular Function, Left, Glucosides, Benzhydryl Compounds, Diabetes Mellitus, Type 2, Hypoglycemia, Hospitalization

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