Sodium–glucose co-transporter-2 inhibitors eligibility in patients with heart failure with reduced ejection fraction

Monzo, Luca; Ferrari, Ilaria; Cicogna, F; Tota, Claudia; Calò, Leonardo

doi:10.1016/j.ijcard.2021.08.035

Cited by 15 publications

(11 citation statements)

References 16 publications

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“…A drawback to our approach is less complete and stringent records on HF status. The eligibility rates we have found among HFrEF-patients are lower than have previously been reported, at 52% vs. 58-69% for DAPA-HF [ 15 – 17 ] and 39% vs. 50-53% for EMPEROR-reduced [ 16 , 17 ]. Similarly to Maltês et al and Monzo et al, our patients are significantly older with worse renal function than trial patients.…”

Section: Discussioncontrasting

confidence: 72%

“…Both DAPA-HF and EMPEROR-reduced have a higher eligibility rate than for sacubitril-valsartan according to PARADIGM-HF-criteria [ 13 ] in our population [ 14 ]. The eligibility rates for DAPA-HF and EMPEROR-reduced have been studied at other centers [ 15 – 17 ] in patients that are regularly followed up at a cardiology outpatient clinic. Our cohort includes a broader category of patients, as we have aimed to include all known HF patients in the community.…”

Section: Discussionmentioning

confidence: 99%

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Eligibility of Dapagliflozin and Empagliflozin in a Real-World Heart Failure Population

Håkansson

Norberg

Själander

et al. 2021

Cardiovascular Therapeutics

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Aims. This study is aimed at investigating the eligibility in a real-world heart failure population for the DAPA-HF (testing dapagliflozin) and EMPEROR-reduced (testing empagliflozin) trials, comparing the eligible real-world patients to trial participants and to characterize the noneligible patients. Methods. Medical records of all heart failure patients who had a diagnosis of heart failure from the Heart Centre or Department of Internal Medicine at Umeå University Hospital were reviewed. Results. 2433 of the hospital’s uptake population of 150 000 had a diagnosis of heart failure. 681 patients had left ventricle ejection fraction ≤ 40 % , and of these 352 (52%) and 268 (39%) patients met eligibility criteria for DAPA-HF and EMPEROR-reduced, respectively. Comparing eligible patients in our population with the DAPA-HF- and EMPEROR-reduced trial populations, we found that eligible real-world patients were older (79.0 vs. 66.2 years and 80.3 vs. 67.2 years, respectively), had worse renal function (eGFR 54.4 vs. 66.0 ml/min/1.73m2 and 49.5 vs. 61.8 ml/min/1.73m2, respectively), higher prevalence of atrial fibrillation (56.0% vs. 36.1% and 53.0% vs. 35.6%, respectively), and lower prevalence of diabetes mellitus (21.0% vs. 41.8% and 26.1% vs. 49.8%, respectively). The main reasons for ineligibility were low NT-proBNP or low eGFR. Noneligible patients differed according to reason for ineligibility, where patients with low NT-proBNP were generally younger and healthier, and patients with low eGFR were older and had more comorbidities. Conclusions. 39-52% of patients with heart failure and reduced ejection fraction in this real-world heart failure population were eligible for SGLT2-inhibitor treatment, corresponding to 11-14% of all heart failure patients. Compared to trial participants, eligible real-world patients were significantly older with worse renal function, more atrial fibrillation, and less diabetes mellitus. Trial entry criteria exclude comparatively young and healthy patients, as well as comparatively old patients with more comorbid conditions.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Eligibility of Dapagliflozin and Empagliflozin in a Real-World Heart Failure Population

Håkansson

Norberg

Själander

et al. 2021

Cardiovascular Therapeutics

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“…SGLT2is have an excellent diuretic and metabolic effect, as well as they may exert several other mechanisms, including neurohormonal modulation and reducing oxidative stress, inflammation and cardiovascular remodeling [ 172 ] ( Figure 2 ). Experimental and clinical studies have demonstrated an excellent nephroprotective effect for this class of drugs, even stronger than that shown by ACEi or ARBs, which are considered the most effective drugs for preserving kidney function in HF patients [ 173 , 174 ]. By inhibiting Na + /glucose cotransporter 2, SGLT2i improves glycemic control and reduces intravascular volume, as well as reduces intraglomerular pressure by contrasting tubuloglomerular feedback with a consequent protective effect on the glomerular endothelium [ 175 ].…”

Section: Therapeutic Strategies In Crsmentioning

confidence: 99%

New Insight in Cardiorenal Syndrome: From Biomarkers to Therapy

Gallo

Lanza

Savoia

2023

IJMS

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Cardiorenal syndrome consists in the coexistence of acute or chronic dysfunction of heart and kidneys resulting in a cascade of feedback mechanisms and causing damage to both organs associated with high morbidity and mortality. In the last few years, different biomarkers have been investigated with the aim to achieve an early and accurate diagnosis of cardiorenal syndrome, to provide a prognostic role and to guide the development of targeted pharmacological and non-pharmacological therapies. In such a context, sodium-glucose cotransporter 2 (SGLT2) inhibitors, recommended as the first-line choice in the management of heart failure, might represent a promising strategy in the management of cardiorenal syndrome due to their efficacy in reducing both cardiac and renal outcomes. In this review, we will discuss the current knowledge on the pathophysiology of cardiorenal syndrome in adults, as well as the utility of biomarkers in cardiac and kidney dysfunction and potential insights into novel therapeutics.

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“…Four out of five HFrEF patients would be eligible for SGLT2i initiation [ 52 ]. Currently, dapagliflozin and empagliflozin are the only SGLT2is approved in the USA for use in this patient population [ 23 , 24 ].…”

Section: Considerations For the Use Of Sglt2is In Clinical Practice F...mentioning

confidence: 99%

Clinical Considerations for Use of SGLT2 Inhibitor Therapy in Patients with Heart Failure and Reduced Ejection Fraction: A Review

Jhalani

2022

Adv Ther

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Heart failure (HF) continues to increase in prevalence, representing a significant burden to healthcare systems in the USA. Despite several established HF therapies, particularly for HF with reduced ejection fraction (HFrEF), rates of HF hospitalizations and cardiovascular (CV) mortality remain very high. Type 2 diabetes (T2D) is an important risk factor for HF, with the two conditions often occurring concurrently. Several CV outcomes trials have shown that the sodium–glucose cotransporter 2 inhibitor (SGLT2i) class of antihyperglycemic drugs reduces the risk of HF-related outcomes in patients with T2D and either established CV disease or multiple CV risk factors. Subsequently, there have been large clinical studies that have investigated the effects of SGLT2is in patients with HFrEF, with or without T2D, which have shown that both dapagliflozin and empagliflozin have significant reductions in hospitalization for HF and CV mortality. These data led to US Food and Drug Administration approval of dapagliflozin and empagliflozin as a novel treatment pathway for patients with HFrEF; empagliflozin has subsequently been approved for the treatment of HF regardless of ejection fraction. A clinical practice algorithm can assist cardiologists in identifying patients who may be eligible for SGLT2i treatment as well as the appropriate timeframe for initiating therapy and the parameters for patient monitoring. Given the evidence that SGLT2is are beneficial in the management of HF, specifically HFrEF, irrespective of underlying T2D, evidence-based recommendations and greater clinician familiarity can facilitate the integration of SGLT2is into general HF therapeutic management.

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Sodium–glucose co-transporter-2 inhibitors eligibility in patients with heart failure with reduced ejection fraction

Cited by 15 publications

References 16 publications

Eligibility of Dapagliflozin and Empagliflozin in a Real-World Heart Failure Population

Eligibility of Dapagliflozin and Empagliflozin in a Real-World Heart Failure Population

New Insight in Cardiorenal Syndrome: From Biomarkers to Therapy

Clinical Considerations for Use of SGLT2 Inhibitor Therapy in Patients with Heart Failure and Reduced Ejection Fraction: A Review

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