Dapagliflozin in heart failure

Dapagliflozin (Forxiga), a SGLT2 inhibitor for treating symptomatic heart failure with preserved or mildly reduced ejection fraction, has been introduced as an option following a NICE technology appraisal in June. Prior to this, standard care was loop diuretics (along with managing any other conditions the patient
may have).

The addition of dapagliflozin along with loop diuretics has been shown to reduce first hospitalisation rates and also the combined risk of dying from cardiovascular causes.

The current approach to management of the disease, known as the ‘four pillars’ of heart failure treatment, includes use of beta-blockers, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists and sodium-glucose co-transporter 2 inhibitors.

Rather than starting on each medication in sequence and titrating the dose up, the latest clinical evidence shows that all medications should be started at once. This reduces the time to get to the appropriate dose for all medications and results in reduced hospitalisations and mortality rates. Additional therapies are then considered as a final step.