Emerging Horizons in Heart Failure with Preserved Ejection Fraction: The Role of SGLT2 Inhibitors

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a condition with increasing disease burden. Prevalence of HFpEF is increasing, reflecting an increasingly elderly and comorbid population, as well as reinforcing the need for more treatments for this disease. The pathophysiology of HFpEF is complex. Some inflammatory processes seen in HFpEF are shared with diabetes mellitus (DM) and there is an association seen between the two conditions. It is therefore no wonder that treatments for diabetes may have some effect on heart failure outcomes. Current treatment strategies in HFpEF are limited, with treatments focusing on symptom control rather than morbidity or mortality benefit. However, there are now promising results from the EMPEROR-Preserved study that show significantly reduced cardiovascular death or hospitalisation for heart failure (HHF) in patients taking empagliflozin, compared to those taking placebo. These results indicate a promising future for sodium-glucose co-transporter 2 (SGLT2) inhibitors in HFpEF. The ongoing DELIVER trial (investigating the use of dapagliflozin in HFpEF) is awaited but could provide further evidence of support for SGLT2 inhibitors in HFpEF. With hospital admissions for HFpEF increasing in the UK, the economic impact of treatments that reduce HHF is vast. The European Society of Cardiology (ESC) recently added SGLT2 inhibitors to their guidelines for treatment of heart failure with reduced ejection fraction (HFrEF) following DAPA-HF and EMPEROR-Reduced trials and we suggest that similar changes be made to guidelines to support the use of SGLT2 inhibitors in the management of HFpEF in upcoming months.

Effectiveness and safety of transcatheter aortic valve replacement in elderly people with severe aortic stenosis with different types of heart failure

“…So far, no significantly beneficial treatment has been established for HFpEF patients. Most therapeutic options of HFpEF focused on symptom control, which is in contrast to the situation of HFrEF [ 35 ]. HFpEF patients represents a more heterogeneous population, some of them have not developed to HFrEF yet and some already have severely symptomatic HF but would maintain a normal EF.…”

Comorbid patient with type 2 diabetes in the postcovid period: clinical case

“…На сегодняшний день существует большая доказательная база в отношении применения указанных препаратов у пациентов с ХСН. Так, в исследованиях DELIVER [11], DECLARE-TIMI 58 [12], EMPEROR-Preserved [13], DAPA-HF [14], EMPEROR-Reduced [15], SOLOIST-WHF [16] было продемонстрировано снижение риска госпитализации по поводу сердечной недостаточности как у пациентов с имеющимися ССЗ, так и при наличии у них факторов рис ка вне зависимости от наличия СД 2 типа. Также помимо достижения первичной профилактики, была выявлена эффективность в отношении предупреждения смертности от сердечно-сосудистых событий.…”

“…Также помимо достижения первичной профилактики, была выявлена эффективность в отношении предупреждения смертности от сердечно-сосудистых событий. Следует подчеркнуть, что на сегодняшний день один из представителей иНГЛТ-2 (дапаглифлозин) показал колоссальные результаты не только в отношении ХСНснФВ, но и у пациентов с сохранной ФВ ЛЖ, что делает эти препараты универсальными для всех пациентов независимо от фенотипа ХСН [11].…”

New Directions in Pharmacological Treatment With SGLT-2 Inhibitor Molecules in the Light of Current Guidelines for Diabetes Mellitus, Heart Failure and Kidney Disease

“…Heart failure is a chronic condition consisting of a variety of signs and symptoms such as elevated intracardiac pressures during exercise or rest, with inadequate cardiac output, peripheral oedema, fatigue and breathlessness. Heart failure with reduced ejection fraction (HFrEF) is the term used to describe this condition when it is accompanied by an ejection fraction (EF) below 40% [11,26]. Heart failure is one of the leading causes of mortality in people with T2DM and it affects more than one in five patients with diabetes aged over 65 years [11,36].…”