Heart failure and reduced ejection fraction (HFrEF) now has two new drugs

1.    Sacubitril/Valsartan
2.    Sodium-glucose cotransporter 2 (SGLT2) inhibitors

In the DAPA-HF trial, treatment with the SGLT2 inhibitor dapagliflozin on top of standard HFrEF medicines, compared with standard medicines only, led to significantly improved risk not only for its clinical composite primary endpoint, but for mortality and a slew of other meaningful secondary outcomes.

The benefits are not mediated by the well-recognized antiglycemic effects of the SGLT2 inhibitor.

DAPA-HF entered more than 4700 patients with HFrEF without regard to their diabetes status.

Patients assigned to receive dapagliflozin on top of standard HFrEF medicines showed at least a one-fourth drop in risk of the clinical primary endpoint compared with those on standard medicines alone over a median of 18 months — also regardless of diabetes status.

The drug had also been shown, in the recent DEFINE-HF trial, to improve symptoms and quality of life in a similar HF population, again in patients with or without diabetes.

SGLT2 inhibitor benefits for HF endpoints in patients who primarily have diabetes have already been established.

(Source: American Heart Association (AHA) Scientific Sessions 2019)

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA