scholarly journals Association of Optimal Implementation of Sodium-Glucose Cotransporter 2 Inhibitor Therapy With Outcome for Patients With Heart Failure

2020 ◽  
Vol 5 (8) ◽  
pp. 948 ◽  
Author(s):  
Nikhil S. Bassi ◽  
Boback Ziaeian ◽  
Clyde W. Yancy ◽  
Gregg C. Fonarow
Keyword(s):  
Heart Failure ◽  
Inhibitor Therapy ◽  
Sodium Glucose Cotransporter ◽  
Patients With Heart Failure ◽  
Optimal Implementation

scholarly journals Management of Heart Failure Patient with CKD

2021 ◽  
pp. CJN.14180920
Author(s):  
Debasish Banerjee ◽  
Giuseppe Rosano ◽  
Charles A. Herzog
Keyword(s):  
Heart Failure ◽  
Angiotensin Receptor Blockers ◽  
Inhibitor Therapy ◽  
High Dose ◽  
Evidence Based ◽  
Angiotensin Receptor ◽  
Sodium Glucose Cotransporter ◽  
Ckd Stage ◽  
Patients With Heart Failure ◽  
Receptor Blockers

CKD is common in patients with heart failure, associated with high mortality and morbidity, which is even higher in people undergoing long-term dialysis. Despite increasing use of evidence-based drug and device therapy in patients with heart failure in the general population, patients with CKD have not benefitted. This review discusses prevalence and evidence of kidney replacement, device, and drug therapies for heart failure in CKD. Evidence for treatment with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and sodium-glucose cotransporter inhibitors in mild-to-moderate CKD has emerged from general population studies in patients with heart failure with reduced ejection fraction (HFrEF). β-Blockers have been shown to improve outcomes in patients with HFrEF in all stages of CKD, including patients on dialysis. However, studies of HFrEF selected patients with creatinine <2.5 mg/dl for ACE inhibitors, <3.0 mg/dl for angiotensin-receptor blockers, and <2.5 mg/dl for mineralocorticoid receptor antagonists, excluding patients with severe CKD. Angiotensin receptor neprilysin inhibitor therapy was successfully used in randomized trials in patients with eGFR as low as 20 ml/min per 1.73 m2. Hence, the benefits of renin-angiotensin-aldosterone axis inhibitor therapy in patients with mild-to-moderate CKD have been demonstrated, yet such therapy is not used in all suitable patients because of fear of hyperkalemia and worsening kidney function. Sodium-glucose cotransporter inhibitor therapy improved mortality and hospitalization in patients with HFrEF and CKD stages 3 and 4 (eGFR>20 ml/min per 1.73 m2). High-dose and combination diuretic therapy, often necessary, may be complicated with worsening kidney function and electrolyte imbalances, but has been used successfully in patients with CKD stages 3 and 4. Intravenous iron improved symptoms in patients with heart failure and CKD stage 3; and high-dose iron reduced heart failure hospitalizations by 44% in patients on dialysis. Cardiac resynchronization therapy reduced death and hospitalizations in patients with heart failure and CKD stage 3. Peritoneal dialysis in patients with symptomatic fluid overload improved symptoms and prevented hospital admissions. Evidence suggests that combined cardiology-nephrology clinics may help improve management of patients with HFrEF and CKD. A multidisciplinary approach may be necessary for implementation of evidence-based therapy.

scholarly journals Towards quadruple therapy for heart failure with reduced ejection fraction: DAPA-HF secondary analysis data

2020 ◽  
Vol 25 (5) ◽  
pp. 3870
Author(s):  
Zh. D. Kobalava ◽  
V. V. Medovchshikov ◽  
N. B. Yeshniyazov
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Sglt2 Inhibitor ◽  
Secondary Analysis ◽  
Analysis Data ◽  
Adverse Outcomes ◽  
Reduced Ejection Fraction ◽  
Sodium Glucose Cotransporter ◽  
Patients With Heart Failure ◽  
First Time

Patients with heart failure with reduced ejection fraction (HFrEF), despite optimal evidence-based treatment, have a high residual risk of adverse outcomes. The favorable results of studies on cardiovascular safety and the effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes (T2D), including outcomes associated with heart failure, were the reason for studying the effectiveness in patients with HFrEF regardless of the T2D status. For the first time in the DAPA-HF study, the SGLT2 inhibitor dapagliflozin in patients with HFrEF showed a positive effect on hard endpoints. Data of the secondary analysis confirmed the effectiveness of dapagliflozin regardless of the T2D status, therapy, age, and quality of life. The results of DAPA-HF have become a serious statement for changing the standards of the guideline-recommended therapy of HFrEF.

scholarly journals Optimizing Guideline-directed Medical Therapies for Heart Failure with Reduced Ejection Fraction During Hospitalization

2021 ◽  
Vol 15 ◽  
Author(s):  
Neal M Dixit ◽  
Shivani Shah ◽  
Boback Ziaeian ◽  
Gregg C Fonarow ◽  
Jeffrey J Hsu
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Outpatient Setting ◽  
Evidence Based ◽  
Mineralocorticoid Receptor Antagonists ◽  
Reduced Ejection Fraction ◽  
Sodium Glucose Cotransporter ◽  
Neprilysin Inhibitor ◽  
Patients With Heart Failure ◽  
Annual Direct Cost

Heart failure remains a huge societal concern despite medical advancement, with an annual direct cost of over $30 billion. While guideline-directed medical therapy (GDMT) is proven to reduce morbidity and mortality, many eligible patients with heart failure with reduced ejection fraction (HFrEF) are not receiving one or more of the recommended medications, often due to suboptimal initiation and titration in the outpatient setting. Hospitalization serves as a key point to initiate and titrate GDMT. Four evidence-based therapies have clinical benefit within 30 days of initiation and form a crucial foundation for HFrEF therapy: renin-angiotensin-aldosterone system inhibitors with or without a neprilysin inhibitor, β-blockers, mineralocorticoid-receptor-antagonists, and sodium-glucose cotransporter-2 inhibitors. The authors present a practical guide for the implementation of these four pillars of GDMT during a hospitalization for acute heart failure.

Dapagliflozin in a real-world population with chronic heart failure: how many would be eligible?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.F.C Maltes ◽  
B.L Rocha ◽  
G.L Cunha ◽  
J.P Presume ◽  
L Campos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Real World ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
World Population ◽  
Ventricular Ejection Fraction ◽  
Disease Modifying Drugs ◽  
Sodium Glucose Cotransporter ◽  
Patients With Heart Failure

Abstract Background In patients with heart failure (HF) and reduced left ventricle ejection fraction (LVEF), the sodium-glucose cotransporter inhibitor (iSGLT2) dapagliflozin has recently been shown to reduce the risk of worsening heart failure or death from cardiovascular causes in the DAPA-HF trial. Results of iSGLT2 in HF with preserved LVEF are awaited. Our goal was to investigate how many patients in a real-world setting would be eligible for dapagliflozin according to the DAPA-HF criteria. Methods This is a single-center retrospective study enrolling consecutive patients followed in an HF Clinic from 2013 to 2019. The key DAPA-HF inclusion criteria [i.e., Left Ventricular Ejection Fraction (LVEF) &lt;40% and NT-proBNP &gt;600pg/mL (or &gt;900pg/ml if AF)] and exclusion criteria [estimated glomerular filtration rate (eGFR) &lt;30ml/kg/1.73m2, systolic blood pressure (SBP) &lt;95mmHg] were considered. Results Overall, 479 patients (mean age 75.7±12.8 years; 50.4% male; 78.8% with hypertension; 45.0% with an eGFR &lt;60ml/min/1.73m2; 36.5% with type 2 diabetes mellitus; 33.5% ischaemic HF) were assessed. Of these, 155 (33.2%) patients had LVEF &lt;40%. Patients had a mean SBP of 131±28 mmHg, a median eGFR of 48 (IQR 33–65) ml/min/m2 and a NT-proBNP of 2183 (IQR 1010–5310) pg/mL Overall, according to the DAPA-HF trial key criteria, 88 patients (18.3%) would be eligible for dapagliflozin. The remainder would be excluded due to a LVEF&gt;40% (67.5%), eGFR &lt;30 ml/min/1.73m2 (19.4%), NT-proBNP &lt;600 pg/mL (or &lt;900 pg/mL if AF) (16.7%) and/or SBP &lt;90mmHg (2.1%) (figure 1). If we limit the analysis to those with a LVEF &lt;40%, 56.7% would be eligible for dapagliflozin. The remainder would be excluded due to a eGFR &lt;30ml/kg/1.73m2 (20%), NT-proBNP &lt;600 pg/mL (or &lt;900 pg/mL if AF) (16.1%) and/or SBP &lt;90mmHg (8.4%) (figure 1). Conclusion Roughly one in every five patients in our real-world HF cohort would be eligible to start dapagliflozin according to the key criteria of the DAPA-HF trial. The main reason for non-eligibility was a LVEF &gt;40%. These findings highlight the urgent need for disease-modifying drugs in mid-range and preserved LVEF. The results of ongoing iSGLT2 trials in these LVEF subgroups are eagerly awaited. Funding Acknowledgement Type of funding source: None

Sodium–Glucose Cotransporter Inhibitors Reduce Mortality and Morbidity in Patients With Heart Failure

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Massimiliano Camilli ◽  
Marco Lombardi ◽  
Juan G. Chiabrando ◽  
Andrea Zito ◽  
Marco G. Del Buono ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mortality And Morbidity ◽  
Sodium Glucose Cotransporter ◽  
Patients With Heart Failure
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