Most HFrEF patients respond and show appropriate recovery when provided with correct medical treatment, however, some patients do not respond to the treatment or experience persistent and recurring symptoms, which is defined as “refractory HF”. These patients suffer from symptoms even at rest or with limited activity and are subject to frequent and extended hospitalizations for intensive care. They are report6ed to have a higher incidence of cardiovascular death. The first step in improving care for refractory HFrEF is to ensure that all standard medical therapy, such as pharmacological therapy and device therapy has been utilized optimally and that all applicable factors have been identified and controlled.

Similarly, a study was conducted to determine the efficacy and safety of dapagliflozin, an SGLT2 inhibitor along with angiotensin receptor blocker ARNI in refractory HFrEF in patients with/without the comorbidity of Diabetes type 2. A retrospective model of the trial was selected with 104 patient information collected and analyzed. The inclusion criteria included symptomatic patients diagnosed between January to June 2020. These patients despite the correct medical therapy including the administration of an SGLT2 inhibitor were admitted to the hospital with refractory heart failure. After treatment, the primary outcome was set at left ventricular ejection seen at the 6th-monthfollow-up while the secondary outcome was determined using changes in NYHA functional class, vital parameters, renal function, potassium level, etc.

After 6 months, the follow-up outcome showed a mean left ventricle ejection rate of 9.00±0.62. The secondary outcome showed an improvement in NYHA function class by 92.6% and 7.4% in class 1 and class 2 respectively. Also, the vital parameters, renal functions, symptomatic hypotension, hypoglycemia, and dyselectrolaemia were seen in normal ranges determining the efficacy and safety profile of the drug. However, large randomized clinical trials are needed to further prove the combination of ARNI and SGLT2 inhibitor is effective and has long-term benefits.

Pankaj Jariwala et al., Indian Heart Journal, Volume 73, Issue 5, 2021,https://doi.org/10.1016/j.ihj.2021.07.005.