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Optimising the Heart Failure Treatment Pathway: The Role of SGLT2 Inhibitors

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Abstract

Sodium-glucose cotransporter 2 (SGLT2) inhibitors were first developed as glucose-lowering therapies for the treatment of diabetes. However, these drugs have now been recognised to prevent worsening heart-failure events, improve health-related quality of life, and reduce mortality in people with heart failure with reduced ejection fraction (HFrEF), including those both with and without diabetes. Despite robust clinical trial data demonstrating favourable outcomes with SGLT2 inhibitors for patients with HFrEF, there is a lack of familiarity with the HF indication for these drugs, which have been the remit of diabetologists to date. In this article we use consensus expert opinion alongside the available evidence and label indication to provide support for the healthcare community treating people with HF regarding positioning of SGLT2 inhibitors within the treatment pathway. By highlighting appropriate prescribing and practical considerations, we hope to encourage greater, and safe, use of SGLT2 inhibitors in this population.

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Authors and Affiliations

  1. Diabetes Resource Centre, University Hospital Llandough, Penlan Road, Llandough, Cardiff, CF64 2XX, UK

    Marc Evans

  2. Health Economics and Outcomes Research Ltd., Cardiff, UK

    Angharad R. Morgan

  3. Department of Cardiology, University Hospital of Wales and Cardiff University, Cardiff, UK

    Zaheer Yousef

  4. Department of Cardiology, Cwm Taf University Health Board, Rhondda Cynon Taf, UK

    Gethin Ellis

  5. East Sussex Healthcare NHS Trust, St Leonards-on-Sea, UK

    Umesh Dashora

  6. Division of Medicine, Department of Diabetes, University College London, Royal Free Campus, London, UK

    Dipesh C. Patel

  7. SA1 Medical Practice, Swansea, UK

    Pam Brown

  8. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Wasim Hanif & Johnathan N. Townend

  9. Northenden Group Practice, Manchester, UK

    Naresh Kanumilli

  10. Stoke Road Surgery, Bishop’s Cleeve, Cheltenham, UK

    Jim Moore

  11. Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Aintree University Hospital, Liverpool, UK

    John P. H. Wilding

  12. Diabetes Research Unit, Swansea University Medical School, Swansea, UK

    Stephen C. Bain

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  1. Marc Evans
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Correspondence to Marc Evans.

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Support for this work was provided by AstraZeneca UK Ltd., who provided funding for medical writing. AstraZeneca UK Ltd. has reviewed this document for factual accuracy only.

Conflict of interest

ME reports honoraria from AstraZeneca, NovoNordisk, Takeda and NAPP, and research support from NovoNordisk outside the submitted work. Marc Evans received financial support for consultancy from Novartis, Merck Sharp & Dohme Corp. and Novo Nordisk, and has served on the speaker’s bureau for Novartis, Lilly, Boehringer lngelheim, Merck Sharp & Dohme Corp., Novo Nordisk, Janssen and Takeda. ARM is an employee of Health Economics and Outcomes Research Ltd., Cardiff, UK, who received fees from AstraZeneca in relation to this study. ZY reports personal fees from AstraZeneca, personal fees from Lilly, personal fees from Boehringer Ingelheim and personal fees from Novartis outside the submitted work. GE has received honoraria for lectures from AstraZeneca, Boehringer Ingelheim, Bayer, Pfizer. UD reports personal fees from AstraZeneca, Napp, Sanofi, BI, Lilly and Novo Nordisk, outside the submitted work. DCP reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Eli Lilly, non-financial support from Napp, personal fees from Novo Nordisk, personal fees from MSD, personal fees and non-financial support from Sanofi outside the submitted work. In addition, DCP is an executive committee member of the Association of British Clinical Diabetologists and member of the CaReMe UK group. PB reports personal fees and non-financial support from Abbott, personal fees and non-financial support from AstraZeneca, personal fees and non-financial support from Boehringer Ingelheim, personal fees and non-financial support from Eli Lilly, personal fees and non-financial support from Janssen, personal fees and non-financial support from MSD, personal fees and non-financial support from Napp, personal fees and non-financial support from Novo Nordisk, personal fees, non-financial support and other from Primary Care Diabetes Society, personal fees and non-financial support from iHeed/University of Warwick, and personal fees and non-financial support from Diabetes UK, outside the submitted work. WH reports grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, grants and personal fees from NAPP, from MSD, outside the submitted work. JNT has nothing to disclose. NK reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Lilly, personal fees from Sanofi, personal fees from Mylan, personal fees from Roche, personal fees from ABBOTT, and personal fees from Napp outside the submitted work. JM has received honoraria from AstraZeneca, Boehringer Ingelheim and Novartis for various activities including attending and participating in educational events and advisory boards. JPHW reports grants, personal fees and other from AstraZeneca, other from Astellas, personal fees and other from Boehringer Ingelheim, other from Janssen, personal fees and other from Napp, grants, personal fees and other from Novo Nordisk, personal fees and other from Mundipharma, other from Sanofi, grants and personal fees from Takeda, other from Rhythm Pharmaceuticals, other from Wilmington Healthcare, other from Eli Lilly, outside the submitted work. SCB reports personal fees and other from Abbott, personal fees and other from AstraZeneca, personal fees and other from Boehringer Ingelheim, personal fees and other from Cellnovo, personal fees and other from Eli Lilly, personal fees and other from Merck Sharp & Dohme, personal fees and other from Novo Nordisk, personal fees and other from Sanofi-Aventis, other from Cardiff University, other from Doctors.net, other from Elsevier, other from Onmedica, other from Omnia-Med, other from Medscape, other from All-Wales Medicines Strategy Group, other from National Institute for Health and Care Excellence (NICE) UK, and other from Glycosmedia, outside the submitted work.

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Authors’ contributions

ME and ARM researched data for the article, contributed to discussion of content, wrote the article and reviewed and edited the manuscript before submission. ZY, GE, UD, DCP, PB, WH, JNT, NK, JM, JPHW and SCB contributed to discussion of content and reviewed and edited the manuscript before submission. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

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Evans, M., Morgan, A.R., Yousef, Z. et al. Optimising the Heart Failure Treatment Pathway: The Role of SGLT2 Inhibitors. Drugs 81, 1243–1255 (2021). https://doi.org/10.1007/s40265-021-01538-6

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