From the Guidelines
SGLT2 inhibitors can begin to show improvements in heart failure with normal ejection fraction within 2-4 weeks of starting treatment, with more substantial benefits observed after 3-6 months of continuous therapy. The most recent and highest quality study, 1, demonstrated that SGLT2 inhibitors, such as empagliflozin and dapagliflozin, can reduce the risk of worsening heart failure and cardiovascular death in patients with heart failure, regardless of their ejection fraction status.
Key Points
- Medications like empagliflozin (10mg daily) and dapagliflozin (10mg daily) are the most commonly used SGLT2 inhibitors for this purpose.
- Patients should continue taking their other heart failure medications while adding the SGLT2 inhibitor to their regimen.
- When starting these medications, patients should be monitored for potential side effects including genital mycotic infections, urinary tract infections, and volume depletion, especially during the first few weeks.
- Blood pressure and kidney function should be checked within 2-4 weeks of initiation.
- SGLT2 inhibitors work by increasing glucose excretion in urine, which reduces cardiac preload and afterload, decreases inflammation and fibrosis in the heart, and improves cardiac energetics.
Benefits of SGLT2 Inhibitors
- Reduced risk of worsening heart failure and cardiovascular death
- Improved cardiac function
- Reduced hospitalizations
- Better quality of life for patients with heart failure, regardless of their ejection fraction status
- The DELIVER trial, 1, demonstrated an 18% reduction in the primary composite outcome of worsening heart failure, defined as hospitalization or urgent visit for heart failure, or cardiovascular death, in individuals treated with dapagliflozin compared with placebo.
Monitoring and Side Effects
- Monitor patients for potential side effects, including genital mycotic infections, urinary tract infections, and volume depletion.
- Check blood pressure and kidney function within 2-4 weeks of initiation.
- Adjust treatment as needed to minimize side effects and optimize benefits.
From the Research
Timeframe for SGLT2 Inhibitors to Improve Normal Ejection Fraction Heart Failure
- The exact timeframe for SGLT2 inhibitors to improve normal ejection fraction heart failure is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that SGLT2 inhibitors have been shown to reduce the risk of heart failure-related outcomes, including hospitalization for heart failure and cardiovascular mortality, in patients with type 2 diabetes and established cardiovascular disease 5.
- Additionally, large clinical studies have investigated the effects of SGLT2 inhibitors in patients with heart failure with reduced ejection fraction (HFrEF), with or without type 2 diabetes, and have shown significant reductions in hospitalization for heart failure and cardiovascular mortality 6.
- The US Food and Drug Administration has approved dapagliflozin and empagliflozin as a novel treatment pathway for patients with HFrEF, and empagliflozin has subsequently been approved for the treatment of heart failure regardless of ejection fraction 6.
Mechanisms of SGLT2 Inhibitors in Heart Failure
- The exact mechanisms for how SGLT2 inhibitors are beneficial in heart failure are unknown, but current hypotheses include multiple metabolic and hemodynamic mechanisms 2.
- SGLT2 inhibitors have been shown to reduce plasma volume contraction, decrease systolic and diastolic blood pressures, and reduce albuminuria, which may underlie cardiovascular and kidney benefits 5.
- The osmotic diuretic and natriuretic effects of SGLT2 inhibitors may also contribute to their beneficial effects in heart failure 5.
Clinical Considerations for Use of SGLT2 Inhibitor Therapy
- A clinical practice algorithm can assist cardiologists in identifying patients who may be eligible for SGLT2 inhibitor treatment, as well as the appropriate timeframe for initiating therapy and the parameters for patient monitoring 6.
- Evidence-based recommendations and greater clinician familiarity can facilitate the integration of SGLT2 inhibitors into general heart failure therapeutic management 6.