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Practical Guidance for the Use of SGLT2 Inhibitors in Heart Failure

Ilaria Cavallari1, Simone Pasquale Crispino2, Andrea Segreti2,3

  • 1Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy. i.cavallari@policlinicocampus.it.

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
|August 24, 2023
PubMed

Insights

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are now foundational for heart failure (HF) treatment, reducing mortality and hospitalizations. This guide addresses barriers to SGLT2i use and offers practical insights for clinicians.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Heart failure (HF) remains a significant global health challenge despite diagnostic and therapeutic advancements.
  • Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have emerged as a crucial therapeutic class for HF.
  • SGLT2i demonstrate efficacy in reducing cardiovascular death and HF hospitalizations across various ejection fraction levels.

Purpose of the Study:

  • To provide an overview of current knowledge regarding SGLT2i in heart failure management.
  • To offer a practical guide for the clinical use of SGLT2i in both new-onset and chronic heart failure.
  • To address potential barriers hindering the widespread adoption of SGLT2i in HF treatment.

Main Methods:

  • Review of current scientific literature on SGLT2 inhibitors and heart failure.
  • Analysis of clinical trial data supporting SGLT2i efficacy and safety in HF.
  • Synthesis of practical recommendations for SGLT2i implementation in diverse clinical scenarios.

Main Results:

  • SGLT2 inhibitors (dapagliflozin, empagliflozin, sotagliflozin) are recommended as foundational HF therapy.
  • These agents offer advantages including few contraindications, low cost, minimal adverse effects, and no titration requirement.
  • Despite proven benefits, SGLT2i prescriptions lag behind the number of eligible patients due to awareness gaps and therapeutic inertia.

Conclusions:

  • SGLT2 inhibitors represent a significant advancement in heart failure management.
  • Addressing barriers to SGLT2i use is essential to improve patient outcomes.
  • This guide aims to equip clinicians with the knowledge to effectively integrate SGLT2i into routine HF care.

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