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Heart Failure Connect, LYNN CRONIN MD Commented on a Post
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Case 1: A 68-year-old female patient presents with fatigue, chest pain, palpitations, dyspnea, and syncope while performing normal physical activity. She is comfortable at rest, with limited impairment of functional status. She is categorized as having HFpEF NYHA Class II, with an LVEF of 58% and an eGFR of 61 mL/min/1.73 m2. She is currently taking ACE inhibitors and diuretics.

Case 2: A 65-year-old man is experiencing symptoms fatigue, chest pain, palpitations, dyspnea, and syncope with less than normal physical activity. He is comfortable at rest only, with limitations on functional status. He recently transitioned to HFpEF NYHA Class III, with an LVEF of 35% and eGFR of 58 mL/min/1.73 m2. He is currently taking an ARB, diuretic, and beta blocker.

In both patients, the addition of which agent would result in a relative risk reduction in time to cardiovascular death or hospitalization due to heart failure? Before prescribing this drug, in which patients should renal function and volume status be tested? What are the most common adverse reactions for this drug (i.e., occurring in ≥5% of patients)?

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  • August 09, 2022
    What are the barriers to care with SGLT2 inhibitors? Is Prior Authorization an issue? Please explain.
  • August 08, 2022
    Case 1: SGLT2 inhibitor Case 2: Change to Entresto and add SGLT2 inhibitor Both may be limited by affordability. I am more cautious in patients whose glycemic control is very Show More
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Consensus statement on the current pharmacological prevention and management of heart failure - PubMed

▪Use of sodium-glucose cotransporter 2 (SGLT2) inhibitors to prevent hospitalisation for heart failure in type 2 diabetes mellitus can be extended to patients with multiple cardiovascular risk factors, albuminuric chronic ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35908234/



Main recommendations: Use of sodium-glucose cotransporter 2 (SGLT2) inhibitors to prevent hospitalisation for heart failure in type 2 diabetes mellitus can be extended to patients with multiple cardiovascular risk factors, albuminuric chronic kidney disease, or atherosclerotic cardiovascular disease ….

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Impact of Non-cardiac Comorbidities on Long-Term Clinical Outcomes and Health Status After Acute Heart Failure in China

BackgroundIndividual non-cardiac comorbidities are prevalent in HF; however, few studies reported how the aggregate burden of non-cardiac comorbidities affects long-term outcomes, and it is unknown whether this burden is associated ..... see more

Source : https://www.frontiersin.org/articles/10.3389/fcvm.2022.883737/full



Conclusion: Among patients hospitalized with HF in this study, a higher burden of non-cardiac comorbidities was significantly associated with worse health-related QoL (HRQoL), increased risks of death, and rehospitalization post-discharge. The findings highlight the need to address the management of comorbidities effectively in standardized...

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SGLT2-Inhibitors on HFpEF Patients. Role of Ejection Fraction - Cardiovascular Drugs and Therapy

Results from DELIVER trial and publication of EMPEROR-Preserved with sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with heart failure (HF) with ejection fraction (EF) > 40% represent a significant step forward in ..... see more

Source : https://link.springer.com/article/10.1007/s10557-022-07371-7



Relevance: Results from DELIVER trial and publication of EMPEROR-Preserved with sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with heart failure (HF) with ejection fraction (EF) > 40% represent a significant step forward in the treatment of HF with preserved EF (HFpEF). However, detailed analysis and attenuation of effect...

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Empagliflozin in the treatment of heart failure and type 2 diabetes mellitus: Evidence from several large clinical trials

Int J Med Sci 2022; 19(7):1118-1121. doi:10.7150/ijms.72772 This issue Review Bo Liang 1,2, Ning Gu 3 1. Nanjing University of Chinese Medicine, Nanjing, China.2. Department of Cardiology, The Second Affiliated ..... see more

Source : https://www.medsci.org/v19p1118.htm



Relevance: Here, we summarize the latest and current understanding of the management for patients with established heart failure and type 2 diabetes mellitus and further present contemporary treatment options, sodium-glucose co-transporter-2 inhibitor, for these particular populations.

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Association between Empagliflozin Use and Electrocardiographic Changes - PubMed

Empagliflozin, a sodium-glucose transporter 2 inhibitor, has been shown to bind to late sodium channels in mice cardiomyocytes. We sought to investigate the electrocardiographic (ECG) features associated with empagliflozin use ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35892445/



Conclusion: We compared ECG features of 101 patients before and after initiation of empagliflozin and found that empagliflozin was associated with a significant increase in QRS duration among diabetes patients with heart failure.



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  • August 02, 2022
    Key Points • Source: Clinics and Practice • Relevance: “Empagliflozin, a sodium-glucose transporter 2 inhibitor, has been shown to bind to late sodium channels in mice cardiomyocytes. We sought to investigate the electrocardiographic (ECG) Show More
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MCAD activation by empagliflozin promotes fatty acid oxidation and reduces lipid deposition in NASH - PubMed

Medium chain acyl-CoA dehydrogenase (MCAD) is one of the significant enzymes involved in β-oxidation of mitochondrial fatty acids. MCAD deficiency affects the β-oxidation of fatty acid and leads to lipid ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35900373/



Conclusion/Relevance: Empagliflozin could upregulate MCAD expression by activating AMPK/FOXA2 signaling pathway, reduce lipid deposition and improve NASH in vivo and in vitro. This research demonstrated that MCAD is a key player of hepatic lipid deposition and it's targeting partially corrects NASH. MCAD thus may be a potential therapeutic...

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Differential In Vitro Effects of SGLT2 Inhibitors on Mitochondrial Oxidative Phosphorylation, Glucose Uptake and Cell Metabolism - PubMed

1 Institute for Biomedicine and Health Sciences (HEALTH), Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010 Graz, Austria. 2 Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35887308/



Relevance: The cardio-reno-metabolic benefits of the SGLT2 inhibitors canagliflozin (cana), dapagliflozin (dapa), ertugliflozin (ertu), and empagliflozin (empa) have been demonstrated, but it remains unclear whether they exert different off-target effects influencing clinical profiles. We aimed to investigate the effects of SGLT2 inhibitors...

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Resting Cardiac Power Predicts Adverse Outcome in Heart Failure Patients With Preserved Ejection Fraction: A Prospective Study

BackgroundWe sought to explore the significance of resting cardiac power/mass in predicting adverse outcome in patients with heart failure with preserved ejection fraction (HFpEF).MethodsThis prospective cohort study included patients with ..... see more

Source : https://www.frontiersin.org/articles/10.3389/fcvm.2022.915918/full



Conclusion: Resting cardiac power determined by non-invasive echocardiography is independently associated with the risk of adverse outcomes in HFpEF patients and provides incremental prognostic information.


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Change of renal function after short-term use of cardioprotective agents in patients with type 2 diabetes is not accurately assessed by the change of estimated glomerular filtration rate: an observational study - Diabetology & Metabolic Syndrome

Background After initiating cardioprotective agents, a fall of estimated glomerular filtration rate (eGFR) has been reported in several studies. Our goal was to evaluate the accuracy of change of Chronic ..... see more

Source : https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-022-00874-1



Conclusion: The agreement between eGFR by CKD-EPI and mGFR is modest and the change of renal function after short-term pharmacological intervention is not accurately and precisely reflected by the change of eGFR in patients with T2D in the early stage of their disease.


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Empagliflozin activates Wnt/β-catenin to stimulate FUNDC1-dependent mitochondrial quality surveillance against type-3 cardiorenal syndrome

Empagliflozin reduces myocardial damage and improves myocardial function after CRS-3. * Empagliflozin normalizes the mitochondrial structure in cardiomyocytes during CRS-3. * Empagliflozin attenuates cardiomyocyte mitochondrial dysfunction during CRS-3. * Empagliflozin ..... see more

Source : https://www.sciencedirect.com/science/article/pii/S2212877822001223?via=ihub



Conclusion: In summary, empagliflozin activated Wnt/β-catenin to stimulate FUNDC1-dependent mitochondrial quality surveillance, ultimately improving mitochondrial function and cardiac performance during CRS-3. Thus, empagliflozin could be considered for the clinical management of heart function following acute kidney injury.


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Sodium-Glucose Cotransporter 2 Inhibitors in Heart Failure with Preserved Ejection Fraction: Rationale for and Practical Use of a Successful Therapy

Until 2021, medical treatment of patients with heart failure (HF) and preserved ejection fraction (HFpEF) was mainly limited to diuretics to improve symptoms of HF, while no therapies demonstrated a ..... see more

Source : https://www.cfrjournal.com/articles/sodium-glucose-cotransporter-2-inhibitors-heart-failure-preserved-ejection-fraction



Conclusion: The authors describe the rationale for this therapy, presenting the main results of the EMPEROR-Preserved trial, and provide some recommendations for the everyday clinical management of HF with preserved left ventricular ejection with an SGLT2I.

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Biomarker-driven prognostic models in chronic heart failure with preserved ejection fraction: the EMPEROR-Preserved trial - PubMed

The combination of NT-proBNP and hs-cTnT along with a few readily available clinical variables provides effective risk discrimination both for morbidity and mortality in patients with HFpEF. A predictive toolkit ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35796209/



Conclusions: The combination of NT-proBNP and hs-cTnT along with a few readily available clinical variables provides effective risk discrimination both for morbidity and mortality in patients with HFpEF. A predictive toolkit facilitates the ready implementation of these risk models in routine clinical practice.

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Cost-Utility Analysis of Combination Empagliflozin and Standard Treatment Versus Standard Treatment Alone in Thai Heart Failure Patients with Reduced or Preserved Ejection Fraction - American Journal of Cardiovascular Drugs

Background Clinical trials reported the benefit of empagliflozin when combined with standard treatment relative to cardiovascular death or heart failure (HF) hospitalization in patients with heart failure with reduced or ..... see more

Source : https://link.springer.com/article/10.1007/s40256-022-00542-9

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Dapagliflozin and Empagliflozin in Heart Failure | IJGM

Sodium-glucose cotransporter-2 (SGLT2) inhibitors, including dapagliflozin and empagliflozin, are a new type of oral glucose-lowering drugs that can control blood glucose by inhibiting SGLT2 in the kidney. The DAPA-HF trial ..... see more

Source : https://www.dovepress.com/dapagliflozin-and-empagliflozin-in-heart-failure-with-reduced-ejection-peer-reviewed-fulltext-article-IJGM



Conclusion: Despite its many limitations, this study suggested that different SGLT2 inhibitors might have differences regarding efficacy in HFrEF. We look forward to future studies to verify our conjectures.

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The Effects of Sodium-Glucose Cotransporter-2 Inhibitors (SLGT-2i) on Cardiovascular and Renal Outcomes in Non-diabetic Patients: A Systematic Review

Globally, cardiovascular disease (CVD) and chronic kidney disease (CKD) are the leading causes of mortality. Despite medical advances, these illnesses are still underdiagnosed and undermanaged. Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have ..... see more

Source : https://www.cureus.com/articles/90198-the-effects-of-sodium-glucose-cotransporter-2-inhibitors-slgt-2i-on-cardiovascular-and-renal-outcomes-in-non-diabetic-patients-a-systematic-review



Relevance: In this systematic review, we explored the outcomes of cardiovascular and renal protective effects utilizing SGLT-2i in three large randomized clinical trials with a cohort of both diabetes and non-diabetes patients.


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Uric acid and sodium-glucose cotransporter-2 inhibition with empagliflozin in heart failure with reduced ejection fraction: the EMPEROR-reduced trial - PubMed

Hyperuricaemia is common in HF and is an independent predictor of advanced disease severity and increased mortality. Empagliflozin induced a rapid and sustained reduction of SUA levels and of clinical ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35788657/


Conclusion: Hyperuricaemia is common in HF and is an independent predictor of advanced disease severity and increased mortality. Empagliflozin induced a rapid and sustained reduction of SUA levels and of clinical events related to hyperuricaemia. The benefit of empagliflozin on the primary outcome was observed independently of SUA.

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Winner Winner Turkey Dinner! An Empirical Approach to Measuring Palatability and Satisfaction with Emergency Department Turkey Sandwiches

Despite their popularity in many EDs, little is known regarding perceptions of turkey sandwiches among patients. Given the importance of turkey sandwiches as a form of nutrition provided in EDs, ..... see more

Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9213106/

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Mild and moderate to severe early acute kidney injury following cardiac surgery among patients with heart failure and preserved vs. mid-range vs. reduced ejection fraction: A retrospective cohort study - PubMed

doi: 10.1097/EJA.0000000000001713. Online ahead of print. 1 From the Department of Anaesthesiology (YG, CW, JL, JW, FY), Department of Cardiopulmonary Bypass (BJ), Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35791895/