Early initiation of SGLT2 inhibitors is important, irrespective of ejection fraction: SOLOIST‐WHF in perspective

Abstract

Trends in 30-day readmission rates for patients hospitalized with heart failure: findings from the get with the guidelines-heart failure registry. Circ Heart Fail 2016; 9.

SGLT2 inhibitors decrease cardiovascular death and heart failure hospitalizations in patients with heart failure: A systematic review and meta-analysis

“…Also, there was substantial variability in the average followup period between studies, ranging from 3 to 50 months. However, the heterogeneity of pooled outcomes was quite low for most outcomes, which corroborates prior findings of an early onset of the benefit of SGLT2 inhibitors [55]. Also, the absence of patient-level data did not allow for the reporting of a pooled number of events.…”

Acute heart failure treatment: a light at the end of the tunnel?

“…What is the explanation for the remarkable benefit observed in the SOLOIST‐WHF study? As described in a recent review, 24 although SOLOIST‐WHF enrolled only patients with diabetes and its results should be explored in non‐diabetic patients too, the absolute benefit seen in SOLOIST‐WHF was three times larger than that observed in studies of SGLT2 inhibitors in chronic HF such as DAPA‐HF 16 and EMPEROR‐Reduced 21 . Some of this larger benefit can be attributed to the higher event rate observed in the control arm since patients were enrolled immediately after an AHF admission.…”

“…Beyond the large effects observed on hard outcomes in the SOLOIST‐WHF study, the study is also notable for enrolling patients with (relatively) low levels of natriuretic peptides and no LVEF restriction. These design features and the lack of interaction seen between the effect size on the primary endpoint and baseline LVEF suggest that patients with AHF may benefit from novel interventions regardless of these characteristics, opening the door to development of new interventions for patients with AHF and HF with preserved and mid‐range LVEF 24,25 …”

SGLT-2 inhibitors in heart failure: Time for broader eligibility and earlier initiation

“…This protocol calls for early addition of SGLT-2 inhibitor therapy (Figure 1), a strategy shown to reduce morbidity and mortality as early as 30 days after initiation. 18,26 Inhospital initiation of therapy with an SGLT-2 inhibitor is also an independent predictor of higher adherence to therapy in patients with worsening heart failure, 27 thus maximizing the clinical benefi t of these agents.…”

“…However, the evidence for SGLT-2 inhibitors from those trials was limited to patients with chronic ambulatory heart failure and excluded patients hospitalized with heart failure fewer than 4 weeks before enrollment. 27…”