New treatments for heart failure

New drug recommendations

Heart failure is characterized by weakening of the muscles and failure of the heart to pump and eject blood. The ejection fraction is the measure of the compression capacity of the left ventricle of the heart. It is considered reduced when it is less than or equal to 40%. Until then, these patients were treated with drugs that help and support their heart in these functions. There were three classes of drugs:

• ACE inhibitors;
• Angiotensin receptor blockers (beta-blockers);
• RNA blockers (antimineralocorticoids).

Now, new guidelines for treating heart failure patients with reduced ejection fraction focus on adding a fourth class of drugs, SGLT2 inhibitors.

SGLT2 inhibitors

These blockers, also called sodium-glucose-2 cotransporter, reduce blood sugar levels. Thus, the kidneys are forced to evacuate the sugar via the urine. Initially, these are drugs prescribed for patients with diabetes. However, two clinical trials have shown that they can be administered to another patient profile, those with heart failure.

This treatment has proven to be effective in reducing the risk of death in this category of patients. Indeed, people recruited for the trials who took SGLT2 (dapagliflozin and empagliflozin) had a longer life expectancy, even in people without diabetes. Also, for the first time, the results are quite accurate. Indeed, according to the authors of the study, this treatment is recommended for patients who suffer from heart failure with ejection fractions between 41% and 49%.

However, the drug is contraindicated in patients with type 1 diabetes or renal failure, as there is a risk of urinary tract infections. Also, the lapse of time between the new recommendations and the application is often long, even if this time the evidence provided seems “solid”. In all cases, it is the doctor who will make the decision whether or not to prescribe SGLT2 to his patients, depending on their state of health.