The ejection fraction is a measure of how well it can compress the left ventricle of the heart. An ejection fraction greater than 50% is considered normal. one at 40% or below is considered reduced.
Previously, people who had heart failure with a reduced ejection fraction were treated with three classes of drugs to reduce the amount of work the heart had to do. One class includes ACE inhibitors, angiotensin receptor blockers, and ARN blockers. Beta blockers are the second category and the third is the anti-mineral corticosteroids.
The new guidelines advise prescribers to add SGLT2 inhibitors as the fourth type of drug for people with heart failure with a reduced ejection fraction.
SGLT2 inhibitors, or the sodium-glucose-2 transporter, lower blood sugar by forcing the kidneys to remove sugar from the body through the urine. This class of drugs, previously used only in people with diabetes, has been found to reduce the risk of death in patients with heart failure.
The new recommendations were based on two clinical trials that found that people with heart failure with a reduced ejection fraction receiving the SGLT2 inhibitors dapagliflozin and empagliflozin lived longer. Both trials showed that this benefit was significant even in people who did not have diabetes.
“When I discuss it with my patients, I explain that the evidence behind these recommendations is very solid. If you get 100 experienced clinicians who have looked at the evidence base, almost all 100 will have to come to the same conclusion that they “It really was a cure,” said Dr. Mark Drazner, president of the American Heart Failure Society and chief cardiologist at UT Southwestern.
For the first time, the guidelines also provide treatment recommendations for people with heart failure with extrusion fractions between 41% and 49%, considered “mildly reduced ejection fractions” and people with ejection fractions of 50% or more, called conserved ejection fractions. . These groups will also benefit from an SGLT2 inhibitor, the recommendations say.
This recommendation is a “moderately strong” one that people should definitely discuss with their doctors, said Dr. Paul Heidenreich, chairman of the committee that wrote the new guidelines; and professor and vice president for quality at Stanford University School of Medicine. Medicine. The level of recommendation depends on the strength of the studies and the magnitude of the benefit provided by the drug.
Although people may be reluctant to add another drug to their regimen, Heidenreich said it was important to stress that “feeling better; staying out of the hospital and living longer are the reasons for taking the drug”.
SGLT2 inhibitors carry a higher risk of urinary tract infections. People with type 1 diabetes or mild to moderate renal impairment should not take it.
Although the guidelines establish a new standard for the treatment of heart failure based on strong clinical evidence, there are often delays in their implementation in the real world.
“There is a gap between the recommendations of the guidelines and what people in the country are really being treated for,” Drazner said. “Unfortunately, many patients do not receive the highest level of recommended treatment.”
Even usage rates for the three previously recommended drug treatment categories for heart failure were “shockingly low,” he said.
Things like drug pricing and clinicians who are late in prescribing drugs contribute to these low rates, he said.
The guidelines also introduced new classification terminology for heart failure.
People who have risk factors such as hypertension, diabetes or atherosclerosis but no evidence of heart failure are considered at risk.
The term “pre-heart failure” is now used to describe people who do not have symptoms of heart failure but have evidence of structural heart disease or higher levels of heart disease biomarkers, such as natriuretic brain peptide (BNP), a circulating protein. blood when the heart can not pump enough blood.
It is also now officially recommended that anyone with advanced heart failure should seek care at a specialist advanced heart failure center. These centers have clinicians who specialize in the later stages of heart disease and can provide treatments such as heart transplants, left ventricular assist devices or palliative care, depending on the patient’s goals.
