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September 2021

New guideline backs SGLT2 inhibitors for heart failure

The new European Society for Cardiology guideline for the management of heart failure recommends early initiation of the SGLT2 inhibitors dapaglifozin and empagliflozin for patients with heart failure with reduced ejection fraction (HFrEF).

SGLT2 inhibitors have been shown to reduce the risk of cardiovascular death and/or hospitalisation for heart failure when added to standard treatment.

Four key drug therapies – ACE inhibitors, ARBs, beta blockers, MRA, and SGLT2 inhibitors – should be initiated as quickly as possible, with tailored or personalised management superseding sequencing of these treatments.

Heart failure with mildly reduced ejection fraction should now be managed in the same way as HFrEF in terms of drug therapy.

At least 1 million people in the UK are affected by heart failure, with 200,000 newly diagnosed every year. Death rates from heart failure are higher than for some of the most common cancers, and the ESC says the condition should be diagnosed and treated with the same urgency as malignant diseases.

The guideline aims to equip primary care with the tools they need to treat ‘vast numbers’ of patients with heart failure in the community and prevent many seeking medical help only as an emergency hospital admission.

British Society for Heart Failure (BSH) chair-elect, Professor Roy Gardner, said: ‘Approximately 80% of heart failure is diagnosed in hospital but 40% of people had symptoms that should have triggered an earlier assessment in primary care.’

The guideline emphasises the importance of measuring N-terminal pro B-type natriuretic peptide (NTProBNP) hormones, in line with the recently-published NHS England and Improvement cardiovascular disease DES for 2022-23.

2021 ESC guidelines for the diagnosis and treatment of heart failure; 27 August 2021.

Practice Nurse 2021;51(7):online only