SLGT2 inhibitors (ex Farxiga®) to treat heart failure?

A word for health professionals about Farxiga®.

You’ll hear debate about whether to use an SGLT2 inhibitor (Farxiga® Or Forxiga® in Canada, etc) to treat heart failure…in patients withOUT diabetes.

Prior evidence suggests that patients WITH diabetes and CV disease or CV risks have fewer heart failure hospitalizations with Farxiga® (dapagliflozin), Invokana® (canagliflozin), or Jardiance® (empagliflozin).

New evidence suggests Farxiga® may benefit some heart failure patients…whether or not they have type 2 diabetes.

Treating heart failure patients with Forxiga for 1.5 years prevents hospitalization or CV death in about 1 in 18 type 2 patients…and 1 in 22 patients withOUT diabetes…versus placebo.

Point out that this is in patients with heart failure with reduced ejection fraction (HFrEF) taking optimized meds shown to improve outcomes…an ACEI or ARB, beta-blocker, and aldosterone antagonist.

Researchers are scratching their heads about the mechanism of benefit. One theory is it may be due to diuretic and BP-reducing effects.

Consider this evidence as more support for using an SGLT2 inhibitor in HFrEF patients WITH type 2 diabetes who need a metformin add-on.

But don’t jump to Farxiga® for patients withOUT diabetes.

Also weigh SGLT2 inhibitor risks…yeast infections, hypotension, acute kidney injury, rare ketoacidosis, amputation, etc.

Instead, focus on optimizing heart failure meds. Fewer than 1 in 5 HFrEF patients are on target doses.

If HFrEF patients WITH diabetes still have symptoms on maximized heart failure meds, lean toward adding Farxiga®…for its HFrEF benefit.

For HFrEF patients who DON’T have diabetes, suggest switching from an ACEI or ARB to Entresto®(sacubitril/valsartan). It impacts heart failure outcomes similar to Farxiga®…and doesn’t add another pill.

But Entresto causes low BP in 1 in 21 patients…should be avoided in patients who’ve had angioedema…

Don’t apply Forxiga®’s results to other SGLT2 inhibitors yet.