Prescribe an SGLT2 inhibitor for heart failure in the absence of diabetes?
An RCT demonstrates that dapagliflozin produces better cardiovascular outcomes than placebo for heart failure patients with and without diabetes.
PRACTICE CHANGER
Prescribe dapagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, 10 mg/d in addition to standard therapies for adult patients with heart failure (HF) with a reduced ejection fraction (≤ 40%) and New York Heart Association (NYHA) class II or greater, regardless of type 2 diabetes history, due to improved heart failure and cardiovascular outcomes.1
STRENGTH OF RECOMMENDATION
B: Based on a single randomized controlled trial.1
McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381:1995‐2008.
CHALLENGES TO IMPLEMENTATION
Adding an SGLT2 inhibitor may be cost prohibitive for some patients
An SGLT2 inhibitor costs, on average, $500 to $600 for a 30-day supply, which may be prohibitive for some patients.11 Integration of SGLT2 inhibitors into a patient’s medication regimen may require dose adjustments of other medications, particularly glucose-lowering therapies, and the optimal prioritization of medications is not yet known.
ACKNOWLEDGEMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
