Treatment of Patients With Heart Failure

An expert panel of cardiologists provide their thoughts on the potential role of SGLT2 inhibitors in treating patients with heart failure.


Neil Minkoff, MD: We’ve had a very rich discussion today and covered a tremendous amount of ground. As we were getting ready, Dr Nissen said he thought it was going to be a long time. We filled it up pretty well, and I think we could go for quite a while longer. But I want to be respectful of everyone’s time, including that of the people who are watching this discussion. I’d like to thank each and every one of you. We’ve had a very informative discussion, and a lot of us learned from each other. I’d like to open it up and get a couple of closing thoughts, and I’ll ask Dr Desai to start, please.

Nihar Desai, MD, MPH: Thanks, Neil, and thanks for moderating. Thanks to Steve and Jaime for a wonderful discussion. As I reflect on it, and I think about where we’ve come with SGLT2 [sodium-glucose cotransporter-2] inhibitors and the patient with cardiovascular disease, diabetes, and chronic kidney disease, there has to be a call to action now. Our clinical practice has to reflect the clinical evidence. What we’ve learned about these therapies is that they are incredibly effective. Though they were developed in many ways as diabetes medications, what we’ve learned about them is that they are quite potent cardiovascular risk-reducing medications, and even effective heart failure therapies. The onus is on all of us to continue to engage with our clinical colleagues and to continue to practice the kind of high-quality, high-value medicine that we all aspire to.

Neil Minkoff, MD: Excellent. Dr Murillo?

Jaime Murillo, MD: Thank you. First of all, thank you for a great discussion. We are definitely supportive of the guidelines. We’re supportive of what they mean to clinical improvement for our patients. SGLT2 inhibitors are not going to be a decision that we’re going to deviate from. We believe the results are valid and important, and we support them. We’ll continue to refine this process, especially with the help of the guidelines. It’s going to make it easier for us to say, “These are the groups that will benefit from them, and we’re not afraid of taking the lead.”

Neil Minkoff, MD: Last, but certainly not least, Dr Nissen.

Steven Nissen, MD: Thank you. First of all, I’ve greatly enjoyed the discussion, and Neil, thank you for moderating in such a skillful fashion. The dialogue has been fantastic. I look back at this now 12 years ago, when we made the decision that we were going to require outcome trials for new drugs for diabetes. I’ve got to tell you that I never dreamed that we would find a class of drugs that could reduce atherosclerotic events, death, all-cause mortality, renal disease, and heart failure, and that the drugs have those benefits not just in people with diabetes, but with other people, as well. I’m very happy that we were able to move forward in a field that had stagnated for decades, and it’s been an explosion of new science. I would leave you with one final thought. We need to better understand how these drugs are working, which I don’t think we understand very well and didn’t talk about much. As we work toward implementation, we also want to understand the science better, and I hope we can do that in coming years. It’s been a dream come true for me, and I’m very pleased with what we’ve accomplished.

Neil Minkoff, MD: I certainly would like to offer my thanks to everyone who participated this morning for great cross-talk and a lot of informative learnings. Thank you to all of you. I’d like to thank everyone in the viewing audience. I speak for all of our panelists when I say that we hope you’ve found this to be another informative American Journal of Managed Care® panel discussion, and hope that you find it useful in your practice.

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