Article Figures & Data
Figures
- Figure 1
Proposed algorithm for initiating sodium-glucose cotransporter 2 inhibitors in acute decompen-sated heart failure.
a Dapagliflozin: No dosage adjustment for eGFR ≥ 25 mL/min/1.73 m2. Manufacturer labeling does not recommend initiation of therapy at eGFR < 25 mL/min/1.73 m2. Sotagliflozin is not indicated for patients with eGFR < 25 mL/min/1.73 m2. For heart failure, empagliflozin is not indicated for eGFR < 20 mL/min/1.73 m2. For type 2 diabetes mellitus, empagliflozin is not indicated for eGFR < 30 mL/min/1.73 m2.
b Direct evidence on the effects of canagliflozin and ertugliflozin on heart failure outcomes is available only in patients with type 2 diabetes mellitus. It remains to be determined if they have similar effects in patients without type 2 diabetes.
eGFR = estimated glomerular filtration rate; NT-proBNP = N-terminal pro-B-type natriuretic peptide; SBP = systolic blood pressure; SGLT-2 = sodium-glucose cotransporter 2
Tables
- TABLE 1
Randomized controlled trials of sodium-glucose cotransporter 2 inhibitors in acute decompensated heart failure
Trial Patients Treatment Results EMPULSE3 N = 530, 67% with left ventricular ejection fraction (LVEF) < 40% Empagliflozin 10 mg/day or placebo for 90 days, started a median of 3 days after hospital admission Early benefit, defined by a hierarchical composite that incorporated all-cause mortality, time to heart failure events, and quality of life (measured by Kansas City Cardiomyopathy Questionnaire Total Symptom Score) with empagliflozin use EMPAG-HF4 N = 59, mean LVEF 45 ± 16% Empagliflozin 25 mg/day or placebo for 5 days, started within 12 hours of admission A 25% increase in cumulative urine output over 5 days without affecting markers of renal function with empagliflozin use SOLOIST-WHF8,9 N = 1,222, 79% with LVEF < 50% Sotagliflozin 200–400 mg/day or placebo for a median of 9 months, initiated before or shortly after hospital discharge A 33% reduction of a composite of cardiovascular death and hospitalizations or urgent visits for heart failure and apparent improvement in quality of life as measured by the Kansas City Cardiomyopathy Questionnaire 12 score at 4 months in sotagliflozin group EMPA-RESPONSE-AHF7 N = 79, 100% with LVEF < 50% Empagliflozin 10 mg/day or placebo for 30 days, initiated within 24 hours of presentation while on intravenous diuretics Significantly reduced composite outcome of worsening heart failure, rehospitalization for heart failure, or death at 60 days in empagliflozin group DAPA-RESIST10 N = 61, 44% with LVEF ≤ 40% Dapagliflozin 10 mg or metolazone 5–10 mg for up to 3 consecutive days, initiated within 24 hours of trial screening Significant weight reductions at up to 96 hours of dapagliflozin use compared with metolazone group DICTATE-AHF11 N = 240, 52% with LVEF < 40% Dapagliflozin 10 mg/day + protocolized diuretic titration or protocolized diuretic titration alone, initiated within 24 hours of presentation Strong signal of improved diuretic efficiency (defined as weight change divided by loop diuretic dose) until day 5 of hospitalization or discharge if sooner DAPA-RESIST = Dapagliflozin Versus Thiazide Diuretic in Patients With Heart Failure and Diuretic Resistance, DICTATE-AHF = Efficacy and Safety of Dapagliflozin in Acute Heart Failure, EMPAG-HF = Empagliflozin in Acute Decompensated Heart Failure, EMPA-RESPONSE-AHF = Effects of Empagliflozin on Clinical Outcomes in Patients With Acute Decompensated Heart Failure, EMPULSE = Empagliflozin in Patients Hospitalized With Acute Heart Failure Who Have Been Stabilized, SOLOIST-WHF = Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post Worsening Heart Failure
