Current Place of SGLT2i in the Management of Heart Failure: An Expert Opinion from India

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Heart failure (HF) presents a significant global health challenge, with high prevalence in India, often affecting younger individuals with type 2 diabetes mellitus (T2DM).
• Approximately 50% of Indian HF patients have comorbid T2DM, highlighting a critical intersection of these conditions.

Purpose of the Study:

• To review updated evidence on the efficacy and safety of Sodium-glucose cotransporter-2 inhibitors (SGLT2i) in managing heart failure (HF).
• To recommend the integration of SGLT2i into HF treatment guidelines, with a specific focus on the Indian patient population.

Main Methods:

• Systematic review of current clinical evidence and trial data regarding SGLT2i in HF patients.
• Analysis of cardiovascular (CV) benefits of SGLT2i beyond glycemic control in diverse HF populations.

Main Results:

• SGLT2i demonstrate substantial cardiovascular benefits in HF patients, independent of their glycemic control status.
• Combined therapy with SGLT2i and guideline-directed medical therapies (GMDT) shows additive effects in enhancing cardiac function and mitigating HF adverse events.
• Evidence supports the use of SGLT2i across a wide spectrum of HF patients, including those with and without diabetes and irrespective of ejection fraction (EF).

Conclusions:

• SGLT2i are recommended as a valuable therapeutic option for heart failure management.
• The benefits extend to broad HF populations, including those with type 2 diabetes, and are effective regardless of ejection fraction.
• Emphasis is placed on the utility of SGLT2i for Indian patients experiencing heart failure.