Heart failure develops when weakened muscles make it harder for the heart to expand and contract to pump blood through the body. Symptoms can include shortness of breath, a persistent cough, swelling in the feet, legs and abdomen, and fatigue and nausea. The new guidelines, published April 1 in the Journal of the American College of Cardiology, add a fourth drug to the regimen of medications already recommended to treat symptomatic heart failure patients who pump too little oxygen-rich blood out to the body with each heartbeat, a condition known as heart failure with reduced ejection fraction. Now new guidelines also recommend medicines known as sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) for these patients. SGLT2 inhibitors, currently approved to lower blood sugar in people with type 2 diabetes, have reduced the risk of premature death by 30 percent in heart failure patients in recent clinical trials, Biykem Bozhurt, MD, PhD, the vice-chair of the committee that drafted the guidelines, said in a statement. “This is a major step forward in reducing mortality rates in this vulnerable population,” said Dr. Bozhurt, a professor of cardiology at Baylor College of Medicine in Houston.
Measuring Heart Failure in Patients
Ejection fraction measures the percentage of blood that the left ventricular chamber of the heart can pump out with each heartbeat. In general, an ejection fraction of 40 percent or less is considered reduced, and 50 percent or higher is considered normal, according to the guidelines. Heart failure patients with reduced ejection fraction should take SGLT2 inhibitors even if they don’t have type 2 diabetes. So should patients with “mildly reduced” ejection fraction, which the guidelines defined as 41 to 49 percent. Some heart failure patients with what’s known as “preserved” ejection fraction — meaning it’s above 50 percent — may also benefit from SGLT2 inhibitors if they have increased left ventricular filing pressure, which makes it harder for the heart to pump out blood. SGLT2 inhibitors are already approved by the U.S. Food and Drug Administration (FDA) to treat certain heart failure patients.
Guidelines Update Heart Failure Classifications
In addition to an expanded drug regimen, the new guidelines also include updated classifications for the stages of heart failure that emphasize the need to treat people who are at risk for the condition but are symptom-free. This includes individuals with obesity, type 2 diabetes, and high blood pressure; early intervention with medication or lifestyle changes may prevent heart failure in these at-risk patients.
