Introduction
Following the 2023 ESC Guidelines update for heart failure, SGLT2 inhibitors (dapagliflozin, empagliflozin) are strongly recommended for cardiovascular outcomes both in patients with heart failure with preserved ejection fraction (HFpEF) and with mildly reduced ejection fraction (HFmrEF). The EMPULSE study supports empagliflozin initiation in acute heart failure, regardless of ejection fraction, demonstrating tolerance and significant clinical benefits. Our study aims to establish the feasibility of early use of SGLT-2 inhibitors in acute decompensated heart failure (ADHF) without HFrEF, exploring prescription rates and reasons for underutilization.
Methods
We retrospectively collected data from 33 consecutive patients admitted from the Emergency Room to our Department with a diagnosis of HFpEF and HFmrEF from August to October 2023. We compared data of systolic arterial pressure, creatinine, glomerular filtration rate (GFR), kaliemia, and hemoglobin values at admission with those at discharge.
Results
Patients had a mean age of 80.7±6, and 55% were male. The mean ejection fraction was 50.8% ± 7.5. The mean BMI was 28.4±5 and 39% of the patients had diabetes. The mean hospital stay was 4.3 ± 2.6 days. The utilization of SGLT2 inhibitors at admission was 18% up to 64% at discharge (p <0.001). Both hemoglobin values and systolic arterial pressure significantly decreased during hospitalization, from 13.1±1.6 g/dl to 12.7±1.8 g/dl (p=0.030) and from 129±15 mmHg to 118±14 mmHg (p=0.003), respectively. Creatinine levels moved from 1.32±0.44 to 1.39±0.44 (p=0.006), while GFR reduced from 51±19 ml/min to 46±15 ml/min (p = 0.012), significantly. Kaliemia remained stable from 4.04±0.47 mEq/l to 4±0.42 mEq/l (p = 0.73). Among patients who didn't receive SGLT2 inhibitors, only two patients (9%) had an absolute contraindication represented by a GFR < 25 ml/min. Discussion Our data confirm that the prescription rate of SGLT2 inhibitors in patients with HFpEF and HFmrEF is still low. Approximately 26% of patients lacked clear clinical reasons for not receiving the treatment. Despite mild reductions in hemoglobin, systolic arterial pressure, and GFR, consistent with the class profile, SGLT2 inhibitors demonstrate safety and tolerability without significant impact on key clinical and laboratory parameters. This underutilization is likely linked to therapeutic inertia, necessitating concerted efforts to bridge this gap.