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SGLT2 Inhibitors for Treatment of Heart Failure
Panelists discuss how SGLT2 inhibitors evolved from diabetes medications to become foundational heart failure therapy with class I recommendations across the ejection fraction spectrum, providing cardiovascular and renal benefits through unclear but likely multiple mechanisms, with the elegant advantage of single-dose efficacy regardless of diabetes status or heart failure type.
EP: 1.Economic Burden of Heart Failure Care
EP: 2.Heart Failure Prevalence and Screening
EP: 3.Quality Metrics in Heart Failure
EP: 4.Heart Failure Stages and Impact of Delayed Diagnosis
EP: 5.Collaboration in Heart Failure Treatment
EP: 6.Guideline-Directed Medical Therapies in Heart Failure
EP: 7.β-Blockers for Treatment of Heart Failure
EP: 8.Role of Diuretics in Heart Failure Management
EP: 9.Treatment of Heart Failure With ARNI Therapy
EP: 10.SGLT2 Inhibitors for Treatment of Heart Failure
SGLT2 inhibitors represent one of the most remarkable therapeutic developments in heart failure care, transitioning from diabetes medications to cornerstone heart failure therapy through an evolutionary research process. Originally studied to establish cardiovascular safety in diabetes, these agents demonstrated unexpected and substantial benefits in heart failure outcomes, ultimately becoming the only medication class with class I recommendations for reducing cardiovascular death and heart failure hospitalizations in patients with heart failure with preserved ejection fraction.
The therapeutic benefits extend across the entire heart failure spectrum regardless of diabetes status, with no significant interaction between diabetes presence and clinical benefit. Multiple mechanisms likely contribute to their effectiveness, including modest diuretic effects, potential ketone metabolism benefits, and natriuretic effects, though the precise mechanisms remain incompletely understood. The elegant simplicity of SGLT2 inhibitors—essentially 1 dose effective across all patients with heart failure regardless of ejection fraction—makes them uniquely practical for implementation.
Clinical application prioritizes SGLT2 inhibitors as foundational therapy for all patients with heart failure, with the choice between SGLT2 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with diabetes depending on individual characteristics. For patients with obesity and poorly controlled diabetes, GLP-1 receptor agonists may be preferred for their superior weight loss effects, while patients without obesity and with well-controlled diabetes may benefit more from SGLT2 inhibitors given their superior renal protective effects. The impending availability of generic SGLT2 inhibitors should significantly improve accessibility and reduce cost barriers to optimal heart failure therapy.
What It Takes to Improve Guideline-Based Heart Failure Care With Ty J. Gluckman, MD
August 5th 2025Explore innovative strategies to enhance heart failure treatment through guideline-directed medical therapy, remote monitoring, and artificial intelligence–driven solutions for better patient outcomes.
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