Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

Abstract

Prevalence of heart failure is increasing worldwide mainly due to the ageing of the population and the improvement in diagnosis and treatment. In recent years, huge progress has been made in the management of heart failure patients. A new definition of chronic heart failure based on left ventricular ejection fraction and its possible trajectories has been reported. New drug classes have been introduced for the treatment of chronic heart failure. In particular, the prognostic benefit of sodium glucose co-transporter 2 inhibitors was demonstrated across all the heart failure phenotypes. Therapies for patients with advanced heart failure (long-term mechanical circulatory supports and heart transplantation) are now indicated also in the case of mild-to-moderate symptoms but with high risk of progression. In patients with acute heart failure, monitoring of urinary sodium and the use of acetazolamide may lead to better decongestion. Importantly, pre- and postdischarge assessment should lead to optimal treatment. Devices and telemonitoring can also be of help. Cardiovascular and noncardiovascular comorbidities are major determinants of the clinical course and need proper management. This review will summarize these important advances.

Left-to-right ventricular volume ratio and outcome in heart failure with preserved ejection fraction

“…The burden of HFpEF is increasing worldwide, and patients with HFpEF typically have a poor prognosis. [21][22][23] An accurate prediction of individual patient prognosis may be important to define tailored care strategies (e.g. frequency of clinic visits, home follow-up by healthcare professionals, or prognosis-related discussions with the patient and his/her family members).…”

“…The burden of HFpEF is increasing worldwide, and patients with HFpEF typically have a poor prognosis 21–23 . An accurate prediction of individual patient prognosis may be important to define tailored care strategies (e.g.…”

Performance of sodium-glucose cotransporter 2 inhibitors in cardiovascular disease

“…SGLT2 inhibitors have been shown to be significant in the treatment of heart failure across the entire spectrum of left ventricular ejection fraction (LVEF), and in particular the prognostic benefit of SGLT2i has been demonstrated for all phenotypes of heart failure. 21 Recent studies demonstrated the results of a reduction in heart failure hospitalizations and cardiovascular fatalities, suggesting that they may have a direct effect on heart failure regardless of their antihyperglycemic properties. When used to treat T2DM, SGLT2 inhibition only slightly decreases hemoglobin A1c while considerably lowering cardiovascular outcomes, indicating that unfavorable cardiovascular events in T2DM are not entirely mediated by dysglycemia.…”

The Importance of Diaphragmatic Function in Neuromuscular Expression in Patients With Chronic Heart Failure

“…In contrast, the most important causes leading to non-ischemic CHF are Myocardial infarction (MI), which is the main cause causing the due to metabolic dysfunction and hypertension [ 1 ]. The prevalence of CHF is continuously increasing, probably due to the parallel increase in aging and the clinical ability to deal with the disease [ 2 ]. The European Society of Cardiology (ESC) highlights two categories of patients based on the left ventricular ejection fraction (LVEF).…”