Recent Studies of SGLT-2s in Patients with HFrEF

Nihar Desai, MD, MPH, reviews details of the DAPA-HF trial evaluating dapagliflozin in patients with heart failure and reduced ejection fraction.

Where do you see the role of the sglt2 inhibitors in heart failure starting with patients with with diabetes yeah it’s it’s a great point i think you know having steve’s perspective on this is it’s just incredible and i think you know in many ways because of his advocacy and kind of thinking deeply about our patients and what they need and what they deserve and

The evidence that practitioners need to make the best decisions for the patient’s are caring for you know the whole world has sort of been transformed you know over the last number of years and i think to his point we saw the data in mpeg and canvas and then declare and and to his point and then we saw complementary data also in real-world analyses that really

Showed that the signal heart failure was incredibly compelling with the sglt2 inhibitors and then i think that the next piece of the puzzle if you will connect all the dots was the dapa hf study so that was a trial of patients with reduced ejection fraction failure on standard background medical therapy randomized to receive data low flows in versus placebo and

It was it was a large trial almost 5,000 patients the standard kind of primary endpoint of cardiovascular death and a hospitalization for urgent heart failure and what you saw was about a 25% reduction in that in that composite endpoint and with directionally consistent effects across the the cv death and the and the overall kind of hospitalization endpoints i

Think the most provocative part of this trial was that only about half the patients in this study actually had diabetes and so though as steve kind of laid out the history of this in such a compelling way that though the sglt2 inhibitors were developed as quote diabetes medications what they have emerged as our cardiovascular risk producing medications and also

Highly effective therapies for heart failure whether you have diabetes or not in fact the investigators from the dap hf study just published the the diabetes and the non diabetics subgroup paper and they showed that the effects are virtually identical so whether the patient has diabetes or not the addition of dapple flows into standard background medical therapy

For heart failure was shown to be highly effective at reducing morbidity and this sort of you know standard composite endpoint so i think each trial was that again that that again is is def hf the the other adapt lecithin but but neel t to your point for that it was you know cuz all the other trials that were done that steve sort of you know walked us through

Emperor egg and canvas and declare those were all patients that had diabetes daba hf again kind of very provocative the entry criteria for dapa hf was you have to have systolic heart failure and yes half the patients had diabetes but the other half didn’t and and the impact of dapple flows and was consistent whether the patients had diabetes or not and i think

That sort of is the next step as we kind of move to thinking about you know what is quote best medical therapy for our patient with reduced ejection fraction heart failure and and and there i think to steve’s point the sglt2 inhibitors really have to come you know forward amongst a somewhat you know crowded field but after you get through the standard background

Of beta-blocker ace inhibitor mra you know the sglt2 inhibitors have really emerged and of course the applicable flows in as the first but there will be additional studies that you know that that will follow with mboga flows in and the other sglt2 inhibitors and and i think we’re all sort of eagerly awaiting those results i think neil sorry the one final point

That i’ll make for that and i think you know this will touch on something that we talked about a little while ago was you know most of what we’ve talked about thus far in terms of therapy for heart failure and this is also dhf has been patients with systolic heart failure but i think what’s also quite important and interesting for the feet our patients is the

Sglt2 inhibitors are also being trialed in patients with preserved ejection fraction heart failure where they could potentially represent if the trials go the way that we all hope they will the first therapy to actually improve outcomes for that set of patients that up until now have very little kind of by way of evidence-based therapies so it’s a very exciting

Time i think and if i may just jump in for one sec neela you know it was to me a very big surprise you know i-i-i knew these drugs were weak diuretics but i didn’t really expect that they would have this big effect and and just to make the point that it it clearly is not their diuretic effect i mean there’s a little bit of you know diuretic effect from the drugs

But hydrochlorothiazide doesn’t you know doesn’t prevent heart failure

Transcribed from video
Recent Studies of SGLT-2s in Patients with HFrEF By AJMCtv