The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure has been updated with new recommendations based on recent data.
Key updates
For heart failure with reduced ejection fraction (HFrEF), the guideline-directed medical therapy (GDMT) comprises 4 classes of medications (GDMT-4).
- renin-angiotensin system inhibition with the following:
- angiotensin receptor-neprilysin inhibitors (ARNis);
- angiotensin-converting enzyme inhibitors (ACEis);
- angiotensin (II) receptor blockers (ARBs) alone;
- beta blockers;
- mineralocorticoid receptor antagonists (MRAs);
- the newly added group, SGLT2 inhibitors (SGLT2is).
For heart failure with mildly reduced LVEF, new medication recommendations include the utilization of SGLT2is. Importantly, SGLT2is have a Class of Recommendation (COR) 2a in HF with mildly reduced EF (HFmrEF), with weaker recommendations (i.e., COR 2b) issued for ARNi, ACEi, ARB, MRA and beta blockers.
For patients with HF with preserved EF (HFpEF), new drug recommendations include the utilization of SGLT2is (i.e., COR 2a); MRAs (i.e., COR 2b); and ARNis (i.e., COR 2b). Of note, a COR 1 is considered “strong,” with benefit >>> risk; COR 2a, “moderate,” with benefit >> risk; and COR 2b, “weak” with benefit > risk.
What role do SGLT2is play in your management of HF and does your use align with the 2022 heart-failure guideline? Which patients are particularly responsive to this class of medications?
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Karen Murphy, DR STEFANA PECHER LLC3yrYes. I use SGLT2 inhibitors for heart failure associated risk reduction especially with patients with diabetes and/or patients at risk for kidney disease progression. Benefits include prevention of cardiovascular Show More
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Virgie Que3yrI would recommend the use of SGLT2 esp. in diabetics not only does it lower BP, some weight loss, CV and renal benefits as well
