How New Heart Failure Guidelines Recommend SGLT-2 Inhibitor Use

A new joint-organization guideline presented at the American College of Cardiology (ACC) 2022 Scientific Sessions in Washington, DC this weekend set new precedence for the use of SGLT-2 inhibitors in preventing and treating heart failure.

The new guideline, presented jointly by the ACC, American Heart Association (AHA) and Heart Failure Society of America (HFSA), incorporates data-proven SGLT-2 inhibitors including dapagliflozin and empaglifozin as recommended standard-care therapies for patients with heart failure with reduced ejection fraction (HFreF).

Additionally, the guideline provided updated definitions to the 4-stage progression of heart failure—starting with high risk and ending with hospitalized, uncontrolled disease—and pharmacological intervention for each stage, dependent on patient’s disease subtype, comorbidities, and other indicators.

In an interview with HCPLive at ACC 2022, guideline writing committee co-chair Biykem Bozkurt, MD, PhD, professor of medicine-cardiology at the Baylor College of Medicine, discussed the new recommendations for SGLT-2 inhibition in all progressions of heart failure—from prevention in stage A, to pre-disease mitigation in stage B, to use in reducing hospitalization and mortality risks in stages C and D.

“So in practice, all clinicians should consider SGLT-2 inhibition as part of the armamentarium of heart failure therapies, and recognize that these are agents that result in survival benefit as well as improvement in hospitalizations in patients,” Bozkurt said.

Bozkurt expressed her excitement for the new recommended utility of this drug class, which advanced from an investigative glycemic control agent, to considered cardiometabolic indications, to now being proven capable as a cardiac agent—regardless of diabetes.

“So in essence, through the whole continuum of heart failure, SGLT-2 inhibition is appearing to be quite beneficial,” Bozkurt said. “And in the aftermath of the EMPULSE trial we do also have evidence of safety as well as efficacy to be able to initiate SGLT-2 inhibition for patients hospitalized with heart failure, regardless of ejection fraction.”

Bozkurt also discussed revised terminology throughout the guideline, as well as the addition of indicators for early-stage heart failure risk to include distinguishable biomarkers. Overall prevention was a key topic in these newest heart failure recommendations—both with newly available therapies and with traditional means of lifestyle modification.

“The things to keep in mind: optimal treatment of block pressure will prevent heart failure and treatment of diabetes with SGLT-2 inhibition prevents future heart failure,” Bozkurt said. “And we also do know that active lifestyle and healthy diet also are helpful in prevention of primordial risk."