From the Guidelines
SGLT2 inhibitors are strongly recommended for patients with heart failure (HF), particularly those with reduced ejection fraction (HFrEF), regardless of diabetes status, as they have been shown to reduce the incidence of heart failure and improve heart failure-related outcomes, including hospitalization for heart failure and heart failure-related symptoms 1.
Key Benefits of SGLT2 Inhibitors in Heart Failure
- Reduce the incidence of heart failure and improve heart failure-related outcomes 1
- Decrease hospitalization for heart failure by 27-39% compared to placebo 1
- Improve cardiovascular death or hospitalization for heart failure in patients with NYHA functional class I-IV and chronic HFpEF (LVEF >40%) 1
- Have additional beneficial effects including reducing cardiac preload and afterload, improving cardiac metabolism, and decreasing inflammation
Recommended Medications and Dosages
Important Considerations
- Patients should be monitored for potential side effects including genital mycotic infections, urinary tract infections, and volume depletion 1
- SGLT2 inhibitors should be used cautiously in patients with severe renal impairment (eGFR <30 ml/min/1.73m²) 1
- The cardiovascular benefits appear to be a class effect independent of their glucose-lowering properties 1
Clinical Trial Evidence
- The EMPA-REG OUTCOME trial showed a 35% reduction in hospitalization for heart failure with empagliflozin compared to placebo 1
- The CANVAS and DECLARE-TIMI 58 trials showed 33% and 27% reductions, respectively, in hospitalization for heart failure with SGLT2 inhibitor use versus placebo 1
- The DAPA-HF trial specifically evaluated the effects of dapagliflozin on the primary outcome of a composite of worsening heart failure or cardiovascular death in individuals with NYHA class II, III, or IV heart failure and an ejection fraction of 40% or less 1
From the FDA Drug Label
JARDIANCE is a sodium-glucose co-transporter 2 (SGLT2) inhibitor indicated: To reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure. To reduce the risk of cardiovascular death in adults with type 2 diabetes mellitus and established cardiovascular disease.
The role of Sodium-Glucose Linked Transporter 2 (SGLT2) inhibitors, such as empagliflozin, in Heart Failure (HF) is to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure 2.
- The main benefit of SGLT2 inhibitors in HF is the reduction of cardiovascular death and hospitalization.
- SGLT2 inhibitors, like empagliflozin, are indicated for adults with heart failure, regardless of the presence of type 2 diabetes mellitus 2.
From the Research
Role of SGLT2 Inhibitors in Heart Failure
- SGLT2 inhibitors have been shown to reduce the risk of composite cardiovascular death or hospitalization for heart failure in patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) 3, 4, 5, 6, 7.
- These inhibitors have been found to be effective in reducing cardiovascular mortality, hospitalizations for heart failure, and all-cause mortality in patients with HFrEF and HFpEF, regardless of the presence of diabetes 3, 4, 5, 6, 7.
- The use of SGLT2 inhibitors as an early, first-line therapy in patients with HFrEF has been proposed, given their favorable effects on mortality, clinical events, and quality of life 4.
- SGLT2 inhibitors have been found to be safe and well-tolerated, with minimal effects on blood pressure, glycaemia-related adverse events, and no excess in acute kidney injury 4, 5, 6, 7.
Benefits of SGLT2 Inhibitors in Heart Failure
- Reduced risk of composite cardiovascular death or hospitalization for heart failure 3, 6.
- Reduced risk of cardiovascular mortality 3, 4, 5, 6, 7.
- Reduced risk of hospitalizations for heart failure 3, 4, 5, 6, 7.
- Improved quality of life 4.
- Renal protective effects and reduced risk of hyperkalaemia 4, 5.
Patient Selection for SGLT2 Inhibitor Therapy
- SGLT2 inhibitors can be initiated in patients with HFrEF and HFpEF, regardless of the presence of diabetes 3, 4, 5, 6, 7.
- These inhibitors can be used in patients with reduced ejection fraction, mildly reduced ejection fraction, and preserved ejection fraction 3, 5, 6.
- Patients with estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m² can be considered for SGLT2 inhibitor therapy 5, 6.