Adriaan Voors, MD, professor of cardiology and director of the Heart Failure Clinic, University Medical Center Groningen, the Netherlands, addresses the lack of prescribing for sodium-glucose co-transporter 2 (SGLT2) inhibitors during hospitalization for acute heart failure by highlighting their benefits and that they are part of guideline-directed treatment.
Many therapies have been trialed for patients with acute heart failure, and the findings have largely been neutral, but with sodium-glucose co-transporter 2 (SGLT2) inhibitors, we know they show benefit within 90 days of treatment initiation. Data from many trials bears this out, explained Adriaan Voors, MD, professor of cardiology and director of the Heart Failure Clinic, University Medical Center Groningen, the Netherlands, who discussed the EMPULSE trial findings at the 2021 American Heart Association (AHA) Scientific Sessions.
How big an issue is the lack of SGLT2 prescribing in the acute heart failure setting?
You can look at it from 2 ways. The first is we know they are beneficial in chronic heart failure, so we want the uptake to be great—to be fast and simple—because the American and European guidelines have both indicated to prescribe the fantastic 4 [an angiotensin receptor-neprilysin inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor] as soon as possible. So being able to already start in hospital might increase the uptake of SGLT2 inhibitors in general.
The other thing is—and I think that's maybe even more important—that for hospitalized patients with acute heart failure, we have hardly any therapies. We've tried many, many therapies, and they didn't seem to work that well; there were neutral trials, many of them. Within 90 days of treatment, there's already a benefit seen with starting the SGLT2 inhibitor in the hospital—so that's a reason by itself already. Even if we didn't have the chronic heart failure trials, that would have been worthwhile to do, but now they fit very nicely together. And therefore I position it as the missing link, because you can start in the hospital, treat for 90 days, and then automatically you move into the chronic phase. And you continue based on the EMPEROR-Preserved, EMPEROR-Reduced, and DAPA-HF trials. Now we have the whole continuum.