Sodium-glucose cotransporter 2 inhibitors and heart failure: the best timing for the right patient

Abstract

Sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially born as anti-diabetic drugs, have shown many beneficial effects on the cardiovascular system, in particular against heart failure (HF). HF is a complex and multifaceted disease that requires a comprehensive approach. It should not be considered as a simplistic cardiac disease, but a systemic disease that leads to multisystemic organ failure and death. Exploiting their pleiotropic effects, SGLT2i are a very valid tool for HF treatment. Beyond the indication to reduce HF hospitalization and death risk, in patients with diabetes mellitus at high cardiovascular risk or with established cardiovascular event, SGLT2i administration reported beneficial effects regarding the wide spectrum of HF manifestations and stages, independently by diabetes mellitus presence. Recent evidence focuses on HF rehospitalization, cardiac and all-cause death reduction, as well as symptoms and quality of life improvement, in patients with chronic HF or with a recent HF decompensation episode. Given the recent finding about the SGLT2i usefulness in HF patients, further studies are needed to define the best administration timing to maximize the SGLT2i-derived beneficial effects.

SGLT2 Inhibitors in Diabetic Patients With Cardiovascular Disease or at High Cardiovascular Risk: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Heart failure is a complex and multifaceted disease that leads to multisystemic mechanisms. SGLT2 inhibitors are a very valid tool for HF with reduced ejection fraction (HFrEF) ( 20 ). It is our believe that, due to the current outcomes which did not distinguish the HFrEF and HF with preserved ejection fraction (HFpEF) with the population included, SGLT2 inhibitors may be a possible important role for HFpEF.…”

“…However, all the results reported were regarding a wide spectrum of disease (including HF and renal impairment) manifestations and stages. Recent studies have indicated that it is important to define the best administration timing and the most suitable patients to maximize the SGLT2 inhibitors-derived beneficial effects ( 20 ). Those may provide new perspectives for the management of patients with diabetes along with HF or renal impairment.…”

Do the Current Guidelines for Heart Failure Diagnosis and Treatment Fit with Clinical Complexity?

“…However, clinical trials showed a benefit for HF patients with CKD in therapy with MRAs [95]. The nephroprotective action has been robustly demonstrated for SGLT2i [96][97][98]. This paradox highlights another limit in the current four-drug therapy approach, recommended by the latest ESC guidelines [1]: treatment is based on LVEF, and it does not consider the different severity stages of HF and kidney involvement.…”

Clinical Support through Telemedicine in Heart Failure Outpatients during the COVID-19 Pandemic Period: Results of a 12-Months Follow Up

“…Heart failure (HF) is a multisystemic disease characterized by repeated hospitalizations and progressive worsening. The correct follow up and therapy titration, particularly during the vulnerable phases among hospitalizations, remain a main target to improve patients’ prognosis [ 1 , 2 , 3 , 4 ]. The 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure recommend that patients, after HF hospitalization, should undergo post discharge outpatient clinical visits following a precise timing [ 1 ].…”